Spinal Stenosis

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Back and neck pain can be profoundly limiting, disrupting everything from daily routines to hobbies and leisure time. When these symptoms persist, they often signal an underlying issue that requires attention. One issue that can cause chronic back and neck pain is spinal stenosis. This condition can lead to ongoing discomfort, challenges performing even simple tasks, and in extreme cases, paralysis.

In this article, we’ll break down what spinal stenosis is, the common signs and symptoms to look out for, and what can cause the condition. We’ll also cover the potential complications if it’s left untreated, how doctors diagnose it, and the treatment options that can help you find relief and get back to living your life. By understanding the impact of spinal stenosis, you’ll be one step closer to taking control of your health and well-being.

Understanding Spinal Canal Stenosis

Spinal stenosis is the progressive narrowing of the spinal canal, the opening that runs down our backbone. This narrowing can put pressure on the spinal cord and nerves that travel through the spine, interrupting signals from the brain responsible for motor and organ function, and sometimes causing pain.

Think of the spinal canal as a protected tunnel that runs through the vertebra of our back. The purpose of this tunnel is to house and protect our nerves and spinal cord, a column of nerve tissue that carries messages from our brain, down the tunnel to the rest of our body. When the tunnel gets smaller, it can put pressure on the spinal cord, interrupting signals to and from the brain.

Often, people with spinal stenosis will have no symptoms. However, others may experience pain, tingling, numbness and muscle weakness. Symptoms can get worse over time as the canal continues to narrow.

This narrowing tends to develop gradually and is often seen in older adults as a result of age-related changes in the spine. In fact, nearly 100% of individuals over the age of 60^[1] show degenerative changes in the lumbar spine on magnetic resonance imaging (MRI), highlighting how prevalent these age-related spinal issues are.

While spinal stenosis most frequently occurs in the neck and lower back, thoracic spinal stenosis—affecting the middle back—is rare. That said, there are two main types of spinal stenosis:

Cervical spinal stenosis (neck): Cervical spinal stenosis develops when the spinal canal in the neck narrows, thereby placing pressure on the spinal cord or nerve roots. This narrowing may result from age-related changes, such as degenerative disc disease, bone spurs, or ligament thickening, which are common in the cervical spine as people age.
Lumbar spinal stenosis (lower back): The most common form of spinal stenosis, lumbar spinal stenosis, involves the narrowing of the spinal canal in the lower back. Studies suggest that lumbar spinal stenosis affects at least 21% of individuals over the age of 60(1). This condition is particularly relevant in understanding age-related mobility challenges.

Common Symptoms Of Spinal Canal Stenosis

Spinal stenosis symptoms vary depending on the type and location of the narrowing within the spine. Cervical spinal stenosis, which affects the neck, often presents differently from lumbar spinal stenosis, which occurs in the lower back. Understanding these distinctions is essential for identifying the type of stenosis and guiding appropriate treatment. Below is a breakdown of the most common symptoms associated with each type of spinal stenosis.

Radiating Nerve Pain

Radiating nerve pain from compression or damage may cause tingling, weakness, or numbness in the limbs.

Neck Pain

Neck pain can result from tension, disc problems, or nerve issues, often causing stiffness and radiating discomfort.

Chronic Back Pain

Chronic back pain may result from degeneration, nerve issues, or strain, impacting posture and mobility.

Chronic Leg Pain

Chronic leg pain may result from nerve, circulation, or joint issues, often affecting comfort and mobility.

Lower Back Pain

Lower back pain may arise from strain, disc issues, or nerve compression, often limiting movement.

Crepitus

Crepitus is a grinding or popping in a joint, often linked to cartilage wear, arthritis, or instability.

Joint Deformity

Joint deformity may result from arthritis, injury, or congenital issues, causing pain and limited function.

Joint Stiffness

Reduced flexibility in joints due to nerve irritation or inflammation.

Difficulty With Fine Motor Skills

Difficulty with fine motor skills may result from nerve, muscle, or joint issues, affecting daily tasks.

Muscle Spasms

Muscle spasms are sudden contractions from nerve issues, dehydration, or fatigue, causing pain and stiffness.

Stiff Hips and Pelvis

Stiffness in the hips or pelvis may result from degeneration, inflammation, or tight muscles, limiting movement.

Foot Drop

Foot drop is a symptom where lifting the front of the foot becomes difficult due to nerve or muscle dysfunction, leading to an altered gait.

Radiating Arm Pain

Radiating arm pain may stem from nerve compression, causing tingling, weakness, or numbness down the arm.

Loss Of Balance

Loss of balance may stem from nerve, muscle, or vestibular issues, raising fall risk and affecting mobility.

Causes Of The Condition

While age-related changes are the most common cause of spinal stenosis, several other conditions and structural issues can contribute to this narrowing. Understanding these causes provides insight into why spinal stenosis occurs and can help inform strategies for prevention and treatment. Below are some of the primary factors that contribute to this condition.

Genetic Risk

Individuals with certain genetic factors can be more susceptible to developing spinal stenosis. These inherited or congenital conditions can lead to structural abnormalities in the spine, increasing the likelihood of the spinal canal narrowing over time. Key genetic contributors include:

Congenital spinal stenosis: Some individuals are born with a naturally narrow spinal canal, a condition known as congenital spinal stenosis. This anatomical predisposition means less space for the spinal cord and nerves, increasing the risk of symptoms developing earlier in life, even without significant degeneration or injury.
Achondroplasia: Achondroplasia, a genetic disorder that affects bone growth, is another condition associated with an increased risk of spinal stenosis. In individuals with this condition, the vertebrae’s abnormal development can lead to spinal canal narrowing, particularly in the lumbar region.
Spondylolisthesis: While often acquired later in life, spondylolisthesis can also have a genetic component. This condition develops when one vertebra slips forward over another, potentially compressing the spinal canal or nerve roots. A genetic predisposition to weaker vertebral structures or alignment issues may contribute to this condition.

Herniated Disc

A herniated disc develops when an intervertebral disc’s soft center pushes through a tear in its outer layer, narrowing the spinal canal and placing pressure on the spinal cord or nerves. Often linked to age-related degeneration, it can also result from injuries or repetitive strain. Depending on the location of the herniation, it may affect the cervical or lumbar spine, contributing to spinal stenosis.

Disc Degeneration

Disc degeneration occurs as the intervertebral discs lose their elasticity, height, and cushioning ability over time. This natural process, often associated with aging, can lead to reduced space in the spinal canal, contributing to spinal stenosis. As the discs deteriorate, they may bulge or collapse, increasing pressure on surrounding nerves or the spinal cord. While common in older adults, other factors like repetitive strain, injury, or genetic predisposition can accelerate degeneration, impacting the cervical or lumbar spine.

Bone Spurs

Bone spurs, or osteophytes, are bony growths that develop along the edges of bones, typically in response to joint damage or arthritis. In the spine, these growths can narrow the spinal canal or press against nerves, contributing to spinal stenosis. Bone spurs commonly form in areas experiencing degeneration, such as the cervical and lumbar spine, and can exacerbate stiffness and discomfort by restricting movement or compressing neural structures.

Arthritis

Arthritis is a significant contributor to spinal stenosis, with various forms impacting the structure and function of the spine. These types of arthritis can lead to inflammation, joint damage, and structural changes that narrow the spinal canal or compress nearby nerves. Key forms of arthritis associated with spinal stenosis include:

Osteoarthritis: Osteoarthritis, the most common type of arthritis, develops due to wear and tear on the joints over time. In the spine, it can lead to cartilage breakdown, bone spur formation, and reduced joint mobility, all of which may contribute to spinal canal narrowing.
Facet joint arthritis: Facet joints, which connect the vertebrae and allow for spinal movement, are often affected by arthritis. When these joints become inflamed or degenerate, they can cause instability, swelling, or structural changes that lead to stenosis.
Rheumatoid arthritis: Unlike osteoarthritis, rheumatoid arthritis is an autoimmune condition that leads to chronic inflammation of the joints, including those in the spine. This inflammation can damage ligaments, joints, and bones, potentially narrowing the spinal canal and contributing to spinal stenosis.

Tumors

Spinal tumors, whether benign or malignant, can contribute to spinal stenosis by occupying space within the spinal canal. These abnormal growths may arise in the vertebrae, spinal cord, or surrounding tissues, leading to compression of the spinal cord or nerve roots. Tumors can develop due to genetic factors, metastasis from other cancers, or unknown causes. While spinal tumors are relatively rare, their presence can significantly narrow the spinal canal and exacerbate symptoms.

Injuries Or Trauma

Spine injuries or trauma, such as fractures, dislocations, or damage from accidents, can contribute to spinal stenosis by altering the alignment or structure of the spinal canal. These events may cause swelling, instability, or fragments of bone to impinge on the spinal cord or nerves, narrowing the canal and exacerbating pressure on surrounding tissues. Acute injuries can lead to immediate narrowing, while chronic instability from past trauma may contribute to stenosis over time.

Other Contributing Conditions

Several additional conditions can contribute to the development of spinal stenosis by altering the structure or function of the spine:

Thickened ligaments: Over time, ligaments in the spine, such as the ligamentum flavum, can thicken and stiffen due to wear and tear or inflammation. This thickening can reduce the available space in the spinal canal, causing increased pressure on nerves or the spinal cord.
Scoliosis: Scoliosis, a condition characterized by an abnormal spinal curvature, can create uneven pressure on the vertebrae and surrounding structures. This misalignment can narrow the spinal canal in specific areas, contributing to stenosis.
Ankylosing spondylitis: Ankylosing spondylitis, a form of inflammatory arthritis, causes the vertebrae to fuse over time, reducing spinal flexibility. This fusion can lead to spinal canal narrowing and increased rigidity, further contributing to stenosis.
Paget’s disease of bone: Paget’s disease is a condition that disrupts normal bone remodeling, leading to enlarged and misshapen bones. In the spine, this abnormal growth can narrow the spinal canal and increase pressure on nerves, contributing to stenosis.

How Medical Professionals Diagnose The Condition

Diagnosing spinal stenosis involves a comprehensive approach to identifying the underlying cause of symptoms and the extent of the condition. Below are the steps healthcare providers take to diagnose spinal stenosis.

Clinical Examination

The diagnostic process for spinal stenosis begins with a thorough clinical examination. This includes:

Medical history: The physician will start by reviewing the patient’s medical history, focusing on symptoms such as pain, numbness, weakness, or mobility issues. They may ask about the onset, duration, and severity of symptoms, as well as activities that worsen or relieve them. Past injuries, surgeries, and family history of spinal conditions are also considered.
Physical examination: During the physical exam, the physician will evaluate the patient’s posture, flexibility, and range of motion. They may test muscle strength, reflexes, and sensation to identify signs of nerve compression. Observing how symptoms respond to different positions or movements, such as sitting, standing, or walking, can provide valuable clues about the condition.

Imaging Tests

Imaging tests are crucial in diagnosing spinal stenosis, as they provide detailed views of the spine’s structure and help pinpoint areas of narrowing or nerve compression. Standard diagnostic tools include:

Magnetic resonance imaging (MRI): MRI is often the preferred imaging method for diagnosing spinal stenosis. It uses powerful magnets and radio waves to create detailed images of the spine, showing soft tissues like discs, ligaments, and nerves. MRI can reveal the extent of spinal canal narrowing and the impact on surrounding nerves or the spinal cord.
X-rays: X-rays are typically used to identify structural issues, such as bone spurs, fractures, or alignment problems, including scoliosis. While they do not show soft tissues, X-rays can provide valuable insights into the bony framework of the spine and potential causes of stenosis.
Computed tomography (CT) scans: CT scans, often combined with myelography, are used when MRI is not an option or when additional detail is needed. CT provides cross-sectional spine images and is particularly effective for visualizing bone abnormalities, such as those caused by arthritis or fractures. Myelography involves injecting contrast dye into the spinal canal to enhance the visibility of the nerves and canal structure.

Additional Tests

In some cases, additional tests like nerve conduction studies or electromyography (EMG) are used to further evaluate spinal stenosis. These tests help assess how well the nerves are functioning and can pinpoint areas of nerve compression or damage:

Nerve conduction studies: This test measures the speed and strength of electrical signals traveling through the nerves. By applying small electrical impulses to specific nerves, medical professionals can identify areas where nerve function is impaired due to compression or narrowing in the spinal canal.
Electromyography (EMG): EMG involves inserting a fine needle electrode into specific muscles to record electrical activity. This test helps determine if muscle weakness or dysfunction is caused by nerve compression from spinal stenosis or another condition.

Complications If Spinal Stenosis Is Untreated

When left untreated, spinal stenosis can lead to a range of serious complications that may significantly impact an individual’s health and quality of life. As the condition progresses, the pressure on the spinal cord and nerves can cause:

Chronic pain: Chronic pain refers to persistent discomfort that interferes with daily activities and overall well-being.
Nerve damage: Prolonged compression of the spinal cord or nerves can result in irreversible damage, causing lasting symptoms.
Loss of mobility: Spinal stenosis can lead to difficulty walking or performing routine tasks due to pain, stiffness, or instability.
Bladder and bowel dysfunction: Compression of the nerves that control bladder and bowel functions may result in incontinence or retention issues.
Muscle weakness: Muscle weakness in the legs or arms can make it difficult to maintain balance or complete physical tasks.
Paralysis: In severe cases, when spinal cord compression is left untreated, it may lead to serious challenges, including partial or complete paralysis.
Decreased quality of life: Ongoing pain, reduced mobility, and associated complications can lead to both emotional and physical challenges that diminish overall well-being.

We provide evidence-based treatments for spinal stenosis

Compass Pain and Wellness offers several treatments for Spinal Stenosis. The right treatment for you will depend on your symptoms, anatomy, and physical findings. Treatments will range from conservative care like physical therapy and lifestyle modifications, to minimally invasive outpatient procedures, to surgical interventions to change the structural composition of the spine.

Our approach begins with non-invasive treatments, prioritizing methods that reduce inflammation, improve mobility, and alleviate pain without surgery. These options are tailored to each patient’s unique needs, offering effective symptom management while minimizing risks.

If conservative treatments are not providing sufficient relief from spinal stenosis, we offer a range of minimally invasive procedures to address the root causes of the condition. Surgical options are considered carefully and recommended only when necessary, ensuring that patients receive the most appropriate and evidence-based care for their condition. Our goal is to help restore function and improve quality of life through a collaborative, patient-centered approach.

Medication Therapy

Medication therapy uses tailored prescriptions to reduce chronic pain and improve daily function and comfort.

Massage

Massage therapy eases muscle tension and improves circulation to support pain relief and overall well-being.

Physical Therapy

Physical therapy improves strength, flexibility, and mobility while addressing pain from injury or chronic conditions.

Mindfulness and Meditation

Mindfulness and meditation help manage chronic pain by reducing stress and promoting emotional resilience.

Epidural Steroid Injection

Epidural steroid injections reduce spinal inflammation to ease pain radiating from nerve compression or irritation.

Nerve Block

Nerve blocks interrupt pain signals from specific nerves to reduce chronic or procedure-related discomfort.

Peripheral Nerve Stimulation

Peripheral nerve stimulation sends mild electrical signals to disrupt chronic pain from damaged peripheral nerves.

Spinal Cord Stimulation

Spinal cord stimulation delivers electrical pulses to block nerve pain and reduce discomfort in the back or limbs.

Trigger Point Injections

Trigger point injections treat muscle knots by relaxing tense tissue and relieving localized pain or stiffness.

Associated Injuries

Spinal stenosis can be caused by various injuries that impact the spine, either directly or indirectly. Traumatic events, such as car accidents, are a common cause of spinal damage, leading to inflammation, structural changes, or nerve compression. Specific injuries include:

Back Injury from Car Accident: The sudden impact from a car accident can strain or damage the vertebrae and soft tissues, potentially causing spinal stenosis over time.
Spinal Cord Injury from Car Accident: If a car accident leads to severe trauma to the spinal cord, it can result in swelling, scar tissue, or misalignment, narrowing the spinal canal and compressing nerves.

Identifying injuries early and receiving appropriate treatments are crucial for managing symptoms and preventing further complications.

Our Providers

Meet our experienced and compassionate team of doctors who specialize in helping you manage your condition. With a patient-centered approach, our doctors work to understand your unique needs and provide compassionate, personalized care. Trust our providers to guide you on your journey to better health and improved well-being.

Dr. Kristi Reed, MD

Dr. Randolph Cribbs, MD

Dr. Carl Balog, MD

References

Kalff R, Ewald C, Waschke A, Gobisch L, Hopf C. Degenerative lumbar spinal stenosis in older people: current treatment options. Dtsch Arztebl Int. 2013 Sep;110(37):613-23; quiz 624. doi: 10.3238/arztebl.2013.0613. Epub 2013 Sep 13. PMID: 24078855; PMCID: PMC3784039.

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