Spinal Stenosis


What is Spinal Stenosis?

Spinal stenosis is a disorder in which the spinal canal narrows. This narrowing can cause pressure on the delicate neural structures, including the spinal cord, cauda equina or exiting nerve roots. It occurs most often in the neck (cervical) or lower back (lumbar).

Causes of Spinal Stenosis

In younger patients a disc herniation is the most common cause of spinal stenosis. Later on spinal degeneration (arthritis) is the main reason. In the spine, arthritis occurs as the disc degenerates and loses water content. This causes collapse of the disc spaces and loss of disc space height.

When we are young, discs have a high water content (left). As discs age and dry out, they may lose height or collapse (right). This puts pressure on the facet joints and may result in arthritis.

Spinal settling results in increased loading of facet joints so they also begin to degenerate and develop arthritis. The joint-lining cartilage wears away and new bone formation occurs to help support the vertebrae. Over time, this bone overgrowth - called spurs or osteophytes - may narrow the space for the nerves to pass through.

As a part of arthritis in the spine the ligaments around the joints become thicker. This also lessens space for the nerves. Once the space has become small enough to irritate spinal nerves, painful symptoms result.

Symptoms of Spinal Stenosis

Presentation varies depending on the location of the stenosis.

Spinal stenosis in the neck presents with neck pain. This pain may radiate into the shoulders or arms, followed by a tingling sensation or numbness in the arms or hands. In severe cases increasing pressure on the spinal cord can lead to myelopathy — progressive weakness in the arms and legs, difficulties with walking and disturbance of bladder and bowel function.

In the lumbar spine (lower back) spinal stenosis presents with low back pain. It can also cause numbness and tingling in the buttocks, legs and feet. Patients may feel a burning sensation or heaviness in the lower limbs when standing straight or walking. These symptoms are often relieved by bending forward or sitting.

Diagnosis of Spinal Stenosis

Diagnosis is based on the presenting symptoms and thorough clinical examination. X-rays will show aging changes, like loss of disk height or bone spurs. CAT scan and MRIs are helpful to further evaluate the condition.

Treatment Options

Nonsurgical Treatment

Nonsurgical treatment options focus on restoring function and relieving pain.

  • Modification of activities, postural training, home exercise program
  • Physical therapy - Stretching exercises, massage, and lumbar and abdominal strengthening often help manage symptoms
  • Anti-inflammatory medications - as pain is caused by pressure on a spinal nerve, reducing inflammation (swelling) around the nerve may relieve pain
  • Pain management injections

Dr Szabo uses this multi-disciplinary approach for the treatment of spinal stenosis.

Surgical treatment

In severe cases or those that are progressively worsening, surgical decompression may be necessary. Dr Szabo will only recommend surgery when nonsurgical treatment options fail to improve the symptoms. Depending on the patient's condition decompression of the spine may require only a minimally invasive laminotomy or traditional laminectomy sometimes combined with spinal fusion.

Interesting related websites:



1How do we treat spinal stenosis?
Decompression procedure performed to reduce pressure on the spinal cord and nerve roots. As a result, Dr Szabo creates more room in the spinal canal.
2What should I avoid doing if I have spinal stenosis?
You should stay active but avoid straining your back. Dr Szabo will recommend suitable exercises and advise on activities tend to aggravate the condition even more.
3What is the final stage of spinal stenosis?
Persistent, throbbing buttock and leg pain that becomes worse when walking is a sign of degenerative spinal stenosis.