What Is Spinal Stenosis?
Ali Moshirfar, MD, is board-certified in orthopaedic surgery. He is a member of the Inova Neuroscience and Spine Institute and Chairman of the Department of Orthopaedic Surgery and Director of spine surgery at Inova Loudoun Hospital.
The term “stenosis” means a narrowing of some sort. Spinal stenosis is the term we use when your spinal canal gets narrowed. The spinal canal is the space inside your spine that houses the spinal cord and nerves, which are responsible for transmitting sensations from your brain to your body.
What causes spinal stenosis?
- The most common cause is general wear and tear that happens over a lifetime. We call this type “degenerative spinal stenosis,” and it tends to happen after age 50.
- Spinal disorders like a herniated disc, a tumor or an infection can also cause it.
- Rarer causes include a problem that was present at birth (congenital), certain genetic conditions and scarring after a previous surgery.
What are the signs and symptoms of spinal stenosis?
- Back pain, which can be mild, moderate or severe, is common.
- Nerve symptoms shooting from the lower back to the legs including numbness, tingling, sciatica-like pain, burning sensations and sensitivity are also common.
- Some people report a feeling of heaviness in the legs.
- With worsening stenosis, symptoms become more constant and the ability to stand and walk gets much more limited.
At first, symptoms may come and go, but they tend to get worse as the stenosis advances. Eventually, they are almost constant. Symptoms tend to get worse with standing and walking and are relieved by sitting or leaning forward.
How is it diagnosed?
To diagnose spinal stenosis, we talk with the patient and get an extensive history of the patient’s symptoms and how they’ve progressed. We pair that with a physical examination and imaging studies (X-rays, MRI, CT scans) to confirm the diagnosis.
What are the nonsurgical treatment options?
We always recommend conservative treatment first. Treatment options include:
- Medication – anti-inflammatories, muscle relaxants and, rarely, pain killers
- Physical therapy
- Activity modification
- Epidural injections – a steroid solution injected at the site of the stenosis by a spine or pain management doctor
Epidural injections can’t be done too frequently, and we generally don’t recommend more than three such injections per year. If the symptoms are constant enough such that more injections are necessary and the relief from each injection is getting less, then surgical options should be considered.
Many people respond well to these nonsurgical treatments, but spinal stenosis tends to get worse over time. Nonsurgical treatments target the symptoms, but they do not change the spinal stenosis itself. Over the years, medications, therapy and injections become less effective and less long-lasting. That’s when it’s time to consider surgery.
What are the surgical options, and how do I know it’s the right time for surgery?
Deciding when to have surgery is a personal choice. For most people, when nonsurgical treatments become less effective and the symptoms are affecting their daily activities (e.g., they can’t walk as much, they have more back or leg pain), they make the decision to review their surgical options with their spine expert.
The good news is, there are lots of surgical treatment options for spinal stenosis, depending on how advanced the condition is. We take additional imaging, including MRI and bending X-rays, to help us develop a surgical recommendations:
- If the spine is stable, a laminectomy can decompress the nerves and give them more room.
- In cases where the spine is unstable, or if the spinal stenosis is so severe that it requires significant bony spine and joint removal, then patients may need a spinal fusion.
- For patients with milder stenosis, dynamic stabilization may be an option. This procedure uses implants to give the spinal nerves a little more room without doing major fusion surgery.
What else should patients know about spinal stenosis?
Spinal stenosis is a condition that will not go away. It’s progressive, which means the wear and tear will proceed, even with nonsurgical treatment. That is our advantage at the Inova Spine Program: We have a great multispecialty team ready to treat this condition at all stages across the spectrum.
At the Inova Spine Program, patients will get an expert spine specialist diagnosis and a one-stop shop for their entire care journey, from nonsurgical options to surgery. No matter what stage you’re in, you’ll get great, coordinated care at the Inova Spine Program.
To learn more about the Inova Spine Program at Inova Neurosciences, visit inovaspine.org.