FAQs of Spinal Stenosis and Treatment Options
Spinal stenosis is narrowing of the opens spaces within the spine, which causes pressure on the spinal cord and nerves that branch of the spinal cord. Commonly caused by wear and tear changes of the spine related to aging, spinal stenosis mainly affects people over the age of 50 years.
How common is spinal stenosis?
The incidence of lumbar spinal stenosis in the U.S. is between 8% and 11%. By the year 2020, lumbar spinal stenosis will be diagnosed in 2.4 million people as the baby boomers age. Spinal stenosis surgery occurs at a rate of 137 per 100,000 Medicare beneficiaries, which may double as the population continues to age.
What are the symptoms of spinal stenosis?
The symptoms of spinal stenosis depend on the part of the spine affected. When narrowing occurs in the cervical (neck) spine, it can cause numbness, weakness, or tingling in the shoulder, arm, and/or hand.
In the lower back, compressed nerves of the lumbar spine may cause pain, cramping, weakness, and tingling in the buttock, leg, and/or foot.
What causes spinal stenosis?
- Congenital problems – Being born with a small spinal canal.
- Overgrowth of bone – Wear and tear of the spinal bones will lead to bone spur formation, which impinges the nerves exiting the spinal canal.
- Thickened ligaments – Ligaments are tough cords that hold the vertebrae bones together. When they become thick and stiff, they can bulge into the spinal canal.
- Herniated discs – The discs serve as cushions between each vertebrae, but they tend to dry out and shrink with age. When this occurs, cracks to the outer layer of the disc can allow some of the inner soft material to escape and press on the spinal cord or nerves.
- Injuries – Car accidents and other major spine trauma can cause small dislocations or fractures in one or more vertebrae. The displaced bone can damage the nerves or cause compression.
- Tumors – Abnormal growths can occur inside the spinal cord, within the membranes that cover the spinal cord, or in the space between the vertebrae and spinal cord.
How is spinal stenosis treated?
The treatment of spinal stenosis depends on the severity of the condition. Options include:
- Medications – The doctor may prescribe tricyclic antidepressants, nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, or opioid pain medications.
- Physical therapy – To improve flexibility, strengthen back muscles, and stretch the soft tissue structures, a physical therapist often works with the patient a couple times each week for 2-3 months.
- Epidural steroid injection (ESI) – A long-acting steroid, with or without an anesthetic agent, is instilled into the epidural space of the spine, at the location of the nerve inflammation. This space is located between the epidural layer and the spinal cord. ESI has an 80-90% efficacy rate, according to a recent clinical study.
- Facet joint denervation – This involves the use of radiofrequency energy to destroy the nerves as they exit the spinal cord. The doctor inserts a small catheter into the facet joint space, which is near the affected nerves. A small needle-like device is used to coagulate the nerves. In a recent study where success was defined as at least 50% reduction in pain, a 76% success rate was seen 7-21 days after the procedure.