Spinal Stenosis

Spinal stenosis is a condition in which the space available for the spinal cord and nerve roots is reduced below normal dimensions. This may occur in any portion of the spine but is most commonly problematic in the cervical and lumber regions. The cause of spinal stenosis is usually related to aging processes, which are experienced universally, but to varying degrees in different individuals. Most commonly symptoms of spinal stenosis present in the 60+ age group. The most common associated complaints include sciatica, pain or weakness in the legs during standing or walking (neurogenic claudication), numbness in the legs, and back pain. Cervical spinal stenosis usually causes neck pain and arm pain. Spinal stenosis can present in a younger age group when a congenitally narrow space for the spinal cord and nerve roots exists. In this case there is little space available for the ageing changes that begin in young adulthood leading to premature onset of spinal stenosis symptoms.

Treatment of initial symptoms of spinal stenosis, whether in the cervical or lumbar spine, is usually symptomatic and non-surgical. This may include: use of medications, spinal cortisone injections (epidural), or physical therapy. The goal of non-surgical treatment is to reduce symptoms. Unfortunately, non-surgical treatment does not correct the underlying problem. When symptoms persist or recur despite reasonable non-surgical care, surgical treatment can correct the problem with expected improvement or resolution of symptoms.

The most common surgical treatment for spinal stenosis depends on whether the condition being treated is in the cervical or lumbar spine. Spinal stenosis in the cervical spine is usually treated with anterior cervical discectomy and fusion (ACDF). Less common procedures include corpectomy/fusion, laminectomy, and laminoplasty. Laminectomy with or without fusion (performed when spondylolisthesis or significant scoliosis is present) is the standard treatment for spinal stenosis in the lumbar region.

The proper diagnosis of spinal stenosis can only be made after evaluation by a spinal specialist. This evaluation will always include a verbal history of symptoms, physical exam, and appropriate diagnostic imaging including x-rays, and MRI or myelogram CT. Invasive medical or surgical treatment should never be recommended on the basis of imaging findings alone. When accepted treatment principles are observed the treatment of spinal stenosis is usually successful with high rates of patient satisfaction.