The spine is made up of joints between each of the vertebrae. With general wear and tear, as well as aging, we can develop arthritis in the spinal joints, just like we might in our hips or knees. Some people will develop spurs and thickening of the ligaments associated with this arthritis, which can push into the spinal canal, if this occurs it can decrease the amount of space in the spinal canal that is available for the spinal cord and nerves. This is called spinal stenosis.
Signs and Symptoms
As with a herniated disc, some people with spinal stenosis do not have any symptoms and may lead a normal life. When the pressure on the spinal cord and nerves becomes too great, one may begin to feel the symptoms. Most commonly these people will describe inability to walk any significant distance. They often will describe feelings of pain in their legs, legs feel “heavy” or “rubbery,” or the legs become too weak and feel as if they are going to give way. Most of these people do not have any problem when they are sitting. The reason for this is that when seated, you are bending forward and this will actually enlarge the space in the canal. Standing will often do the opposite and decrease the canal space, therefore many people will note that they cannot stand for any prolonged period or they get symptoms down their legs. It is common to hear that the patient will lean forward over the grocery cart to feel better and allow them to walk further (remember bending forward increases the space in the spinal canal and therefore takes some of the pressure off).
As spinal stenosis progresses and the canal space gets smaller, the person will note the distance that they can walk without sitting or resting will become less and less.
Just as with any cause of pressure on the spinal nerves, if you experience loss of bladder control or numbness around your rectum or genitals, you need to see your doctor immediately.
Your history and physical only suggests the diagnosis. It must be proven with testing. The prefered test is the MRI (magnetic resonance imaging) or a CT scan and myelogram of your spine. Other tests may also be needed. It is best not to do this expensive testing if you do not plan on having treatment other than medication at this stage. This testing may have to be done again when you do consider surgery.
This is a myelogram:
- This represents a cut off of the flow of the dye. The bright white area between the white lines is the dye flowing down the spinal cord. Normally this is visible lower in the picture, but because it is cut off early, this represents spinal stenosis.
- Shows narrowing of the dye.
- This is the same cut off of the flow of the dye as in #1, but from the side. In this case, the stenosis is due to the spondylolisthesis.
Your spinal stenosis may be mild enough that you can simply lose weight and exercise. Other treatments that may help are anti-inflammatory pills, epidural steroid injection, bracing, etc.
You should only have surgery when you are ready. When you can no longer live with your pain or it really limits your ability to walk or stand, it is time to consider surgery.
If you have weakness in your legs or you start having trouble controlling your bladder or bowels, this is an emergency and may require immediate surgery.
In order to correct this problem, the size of your spinal canal needs to be enlarged. To do this in surgery, some bone and ligament are removed from the spinal canal to make room for the nerves. This is done with special instruments and magnification allowing me to look in the spinal canal to remove sources of pressure on the nerves. This is known as a decompression.
Your history and physical only suggests the diagnosis of spinal stenosis. It must be proved with testing. An MRI (magnetic resonance imaging) or a CT scan and myelogram of your spine, as well as other testing may also be needed to determine if you are a candidate for surgery.