Spinal stenosis is a common source of back pain caused by the narrowing of the spinal canal and irritation of the spinal cord. The causes might vary, and depending on where the pain occurs, we can distinguish between different types of spinal stenosis. Understanding the underlying issues, symptoms, and available treatment methods can bring you closer to getting relief for your back pain.

What is spinal stenosis?

The spinal canal is a space that runs through the entire length of our spine, surrounded by vertebrae. Its function is to protect the spinal cord and the spinal nerves.

Spinal stenosis is a medical condition where the space in – or around – the spinal canal narrows, restricting the nerves or the spinal cord, leading to nerve pain and other symptoms.

Types of spinal stenosis

We can distinguish between different types of spinal stenosis depending on which part of the spine (lumbar, thoracic, or cervical) they occur in and if they affect the spinal cord or the nerves branching from it.

Lumbar spinal stenosis

Lumbar stenosis is the most common form of spinal stenosis and affects the lower back (from L1 to L5 vertebrae). Symptoms can be felt throughout the back, the buttocks, or the legs.

Cervical spinal stenosis

Cervical stenosis occurs in the neck area of the spine (from C1 to C7 vertebrae), which might cause tingling, numbness, nerve pain, and muscle weakness in the neck, radiating to the shoulders, arms, and hands. In some cases, cervical stenosis might also cause muscle weakness in the legs and balance problems.

Central canal stenosis

Central canal stenosis happens when the center part of the spine, the spinal canal, narrows, putting pressure on the spinal cord or the cauda equina. It might cause inflammation and weakness in the back and other affected areas.

Foraminal stenosis

Many nerves branch out to the sides of the spinal cord. These are called spinal nerves, and they go through the nerve root canals found on the sides of the spine. When these canals get constricted, it can pressure these nerves, causing foraminal stenosis, also known as lateral stenosis. This might lead to nerve pain, muscle weakness, numbness, and tingling in various areas depending on the affected nerves.

Spinal stenosis symptoms

The symptoms of spinal stenosis can vary depending on whether it affects the spinal cord or the spinal nerves and the area of the spine where the problem occurs.

Some people with spinal stenosis might never have any symptoms, while others might experience a wide range of them. Spinal stenosis might cause the following symptoms:

• Back- or spine pain
• Nerve pain in the limbs, shoulders, buttocks, neck, or the back
• Tingling sensation
• Numbness
• Muscle weakness
• Balance problems
• Difficulty controlling bowel or bladder movements

The symptoms of spinal stenosis often occur slowly at first and worsen gradually over time. Certain positions might alleviate the pressure on the nerves, temporarily making these symptoms less apparent.

Spinal stenosis might lead to other, more specific, medical conditions. We will list some of these below.

Cauda equina syndrome

The cauda equina is a group of nerve roots at the bottom of the spine, in the lumbar and sacral area. These nerves play a vital role in controlling bladder and bowel functions and the movement of the legs. If these nerves get constricted, it might cause problems in these areas, a condition called cauda equina syndrome. If you experience nerve pain and difficulty controlling the functions mentioned above, you should seek medical help immediately.

Sciatica

The sciatic nerve stems from the lower back and runs throughout the buttocks and the legs. Its function is to transfer sensations and control movement. When the sciatic nerve gets irritated or constricted, it might lead to burning or needle-like pains, tingling, and numbness in the affected areas. This condition is called sciatica.

Neurogenic claudication

Neurogenic claudication, also known as pseudo-claudication, is a common symptom of lumbar spinal stenosis. The compression of the spinal nerves causes nerve pain, tingling, numbness, weakness, heaviness, or cramping in one or both legs. A characteristic sign of neurogenic claudication is that it might get better or worse, depending on your posture. You might experience relief when leaning forward or sitting down.

Spinal stenosis causes

Spinal stenosis might occur naturally due to old age, but in most cases, it goes unnoticed without any symptoms. However, some underlying causes might lead to more severe spinal stenosis, where the symptoms are apparent and can have a severe impact on your everyday life.

• Injuries – Accidents, blunt force trauma, sprains, or other issues might damage the bones, muscles, ligaments, or tissues around the spine, leading to spinal stenosis.
• Bone growths – Osteoarthritis, Paget’s disease, or other conditions can lead to unnatural bone spurs in the spinal area. These bone growths might constrict the spinal canal or nerve root canals and lead to spinal stenosis.
• Inflammation or infections – Overuse, inflammatory arthritis, autoimmune diseases, or infections might cause inflammation in the surrounding tissues, potentially leading to swollen muscles or thickened ligaments pressing on the spinal cord or the nerves.
• Disk problems – The spinal disks are soft, shock-absorbing cushions in the spine. These disks might get misaligned, herniated, or damaged in other ways, pushing into the spinal canal, causing nerve irritation.
• Tumors or other growths – In rare cases, tumors or other tissue growths might occur near the spine, potentially constricting the available space and leading to nerve problems.
• Poor posture – Severe cases of poor posture or keeping the spine in unnatural positions for long periods of time might also lead to spinal stenosis.

The risk factors for spinal stenosis include old age, repeated stress or injury to the spine area, and poor posture.

Diagnosing spinal stenosis

When diagnosing spinal stenosis, your doctor will perform a physical examination and ask about your symptoms and medical history.

Spinal stenosis is fairly easy to diagnose using X-rays and MRI or CT scans. These imaging tests often reveal the source of the issue, showing herniated disks, bone spurs, tumors, and muscle or ligament damage.

Spinal stenosis treatments

The recommended treatment methods for spinal stenosis largely depend on the underlying issue. Doctors will focus on solving the causes while providing relief for the symptoms.

Physical therapy

Physical therapy can help alleviate spinal stenosis symptoms or even fix the problem entirely. Building muscle strength can help stabilize the spine, gentle stretches can help realign the bones, and massage or other forms of movement might help with swollen muscles.

Certain forms of exercise might improve flexibility and balance as well.

Pain management

Pain management is a vital part of most treatment plans. It can make the healing process more comfortable or provide relief for chronic cases of spinal stenosis.

• Analgesics – These simple painkillers might provide relief for minor pains
• Nonsteroidal anti-inflammatory drugs – NSAIDs can alleviate pains while at the same time reducing inflammation in the body
• Steroid injections – Steroids are potent medicines that can help with inflammation, swollen tissues, and severe pain
• Opioids – Opioids provide very strong pain relief, but because of their addictive nature, they are usually only considered a last resort option
• Alternative pain relief options – Herbal medicines, natural agents, and drug-free pain management options can help relieve pain with minimal side effects or provide a supplementary pain management option alongside traditional methods

Surgery

Doctors might recommend surgery in some cases, which might correct issues like herniated disks or bone deformities. The goal is to expand the available space in the spinal or nerve root canals.