Stenosis simply means “narrowing.” In the spine, this is generally due to degenerative spine changes or congenital conditions. Spinal stenosis can lead to many different patient complaints, whether cervical (neck) stenosis or lumbar (low back) stenosis.
Spinal stenosis is often due to spine degeneration and osteoarthritis of the spine. When arthritis starts to build up in the spine, this narrows the space available for the nerves that travel within the spine itself, leading to spinal stenosis. In the low back, this can cause low back pain and pain/aching/numbness in the legs that is worse with standing. When stenosis occurs in the neck, this can lead to more serious problems since the spinal cord itself is located here; this is termed cervical myelopathy. For more information on myelopathy, see our educational section on Myelopathy.
Many patients with lumbar spinal stenosis typically have worse symptoms when standing or walking, and feel some relief when bending forward or sitting down. This occurs because as we stand upright, this causes even more narrowing of the space for the nerves in our spine, leading to even more irritation. However, when we bend over or sit forward, this opens up those spaces, often relieving symptoms within a matter of minutes. This creates the typical “shopping cart” sign, where many patients who have spinal stenosis lean forward on the shopping cart while walking at the store. While spinal stenosis cannot be reversed without surgery, the symptoms it causes can be controlled with non-operative treatment options such as physical therapy and spinal injections. If surgery is ultimately needed, there are a variety of treatment options which can be discussed with your surgeon.
The spinal column contains open spaces that create passageways for the spinal cord and the spinal nerves. Spinal stenosis is a narrowing of (or an intrusion into) these openings. This can cause a compression of the nerves. Spinal stenosis most commonly affects the cervical and lumbar regions of the spine.
Each vertebra has a large opening at the rear called the spinal canal. In the cervical and thoracic regions of the spine, the spinal cord travels through this space. In the lumbar region of the spine, this opening contains a bundle of nerve roots. Openings called foramina branch away from the spinal canal. These spaces provide pathways for the nerve roots that travel from the spine to other parts of the body.
In a spine with stenosis, one or more of these openings are narrowed. The spinal nerves can become compressed against the vertebral bone. This can interfere with nerve function. It can cause pain in the spine or in other parts of the body.
Stenosis is commonly caused by an excess growth of bone around the spinal nerves. This excess bone growth often results from osteoarthritis. Stenosis can also result from a dislocation or a fracture of the vertebral bone. Stenosis can be caused by soft tissue intruding into the spine’s open spaces. Herniated discs, tumors, and thickened spin alligaments can press against the spinal nerves. And in some cases, a person is born with a small spinal canal that does not provide enough room for the spinal nerves.
Symptoms of spinal stenosis can vary depending on the location and severity of the problem. Spinalstenosis can cause pain, weakness, numbness and tingling in the arms and legs. Spinal stenosis in the lower back commonly causes sciatica, a sensation of burning pain that can travel through the buttocks and down the legs. Spinal stenosis can also cause problems with control of the bladder and bowels.
Treatment options for spinal stenosis may include anti-inflammatory medications, muscle relaxants and medications to relieve pain. Steroid injections may be beneficial. A physician may also recommend physical therapy. If these methods are not effective, surgery may be needed to eliminate pressure on the nerves.