Spinal stenosis is a narrowing of the spinal canal and typically occurs in the cervical (neck) or the lumbar spine (lower back). The narrowing of the canal means that the spinal cord or the spinal nerves are compressed. The result is typically back pain, and pain that can radiate into the buttocks and into one or both legs. There can also be pins and needles, leg weakness and bladder and bowel problems. It is worth noting that there can be spinal stenosis and no symptoms at all felt by the patient. This is shown when a patient is for example is given an MRI scan for something else and the spinal stenosis is then found. Spinal stenosis can thus be asymptomatic and is said to occur to many of us as we age, and can be viewed as degenerative in nature. This means that stenosis is a type of arthritis.

 

 

However, often the stenosis does give problems and the patient typically goes to see a doctor complaining of back pain with leg symptoms. The leg pain is typically in both legs and equal in severity, but it can be more one sided too. The back pain can almost always be made better by bending forwards and often there is very little or no pain at all when sitting down or lying on one side. Pain is made worse by bending backwards, walking or by lying flat in the bed. The leg pain experienced is often called neurogenic claudication. This means that the nerves or spinal cord being compressed in the spinal canal gives pins and needles, weakness, numbness, tingling, cramping of muscles in the legs. Bowel and bladder changes can also occur. A herniated or prolapsed disc can also give these symptoms, but the patient with a herniated disc is usually younger. Additionally the problem of stenosis is a gradual worsening, whereas a herniated disc is a sudden onset of severe pain.

Diagnosis is normally made by a subjective and objective examination, and can be further confirmed by an MRI or CT scan. X-rays can occasionally show stenosis.

There are no sure or quick fixes to stenosis. Current research has found that physical therapy is as effective as surgery for lumbar stenosis, where previously surgery had been shown to be superior to physical therapy. This means that the patient need to be informed fully of all the current research and a shared management plan be agreed upon.

 

NSAIDs, opioid analgesics and muscle relaxants are often prescribed for stenosis and steroid injections can also be used.

 

Physiotherapy will consist of manual therapy, postural advice and exercise therapy. The specific exercises are aimed at opening up the spinal canal to reduce the pressure on the cord or nerves and strengthen the core muscles around the spine. Aerobic exercise such as using a bicycle is encouraged and often well tolerated by patients due to the flexed position. A push bike or a static exercise bike can be used.

 

There are various surgical approaches available and the approach depends on the surgeon and the severity of the stenosis. Lumbar decompressive surgery and fusions are commonly used. Surgery aims to widen the spinal canal again and stabilize the spine. Up to 3 level of vertebrae can be operated upon.