While getting older often means getting smarter and wiser and accumulating many diverse life experiences, it also means accumulating years of wear and tear on the body. One important part of the body that is no exception to the effects of aging is the spine. In fact, according to the American Academy of Orthopaedic Surgeons, around 95% of people will experience some kind of degeneration of the vertebral column by the age of 50. One example of such a change is the narrowing of the spinal canal, a condition known as spinal stenosis.
About the Spine
Though we usually don’t think of the spine unless something is wrong, the truth is that spinal health is an important part of overall health and the ability to live a normal, active lifestyle. Also known as the vertebral column, the spine is the primary means of support and stability for the torso. Indeed, humans and other animals with spines are distinct in the animal kingdom and are classified as vertebrates, a subphylum in taxonomic rankings.
In addition to providing support for the body’s overall skeletal structure through stacked vertebrae and intervertebral discs, the spine houses the spinal cord within the spinal canal. The spinal cord is essentially a long bundle of nerves that, along with the brain, comprise the central nervous system. Nerves all over the body run through the spinal cord and communicate signals back and forth with the brain. Unsurprisingly, then, damage or alterations to the spine or spinal cord can have significant consequences for motor skills and sensory perceptions.
What is Spinal Stenosis?
Spinal stenosis is technically defined as a narrowing of one or more spaces within the spinal column, but the term is typically used by doctors to refer to the group of related symptoms. As these vertebral spaces gradually narrow, they begin to exert pressure on the spinal cord or nerve roots. The pressure and compressed space can lead to a variety of symptoms and related conditions, like low back pain or sciatica, yet some people experience no symptoms at all.
There are three types of spinal stenosis, and the type depends on which part of the spinal column the narrowing takes place: cervical spine, thoracic spine, or lumbar spine. The most common type is cervical stenosis in the vertebrae around the neck, followed by lumbar spinal stenosis in the lower back. Thoracic stenosis occurs in the mid-back region of the spine, but it is a much more rare occurrence.
Symptoms of Spinal Stenosis
The type and intensity of symptoms a person can experience with spinal stenosis is largely dependent on the location in the spine. Below are some of the most common symptoms:
- neck pain
- weakness in the extremities
- numbness or tingling in arms or legs
- loss of balance or difficulty walking
- bowel or bladder dysfunction (in severe cases)
- middle or lower back pain
- weakness in the feet or legs
- numbness or tingling in feet or legs
- pain or cramping in the legs when standing or walking for an extended period
What Causes Spinal Stenosis?
As noted above, spinal stenosis tends to develop more frequently in people over the age of 50 and age-related spinal compression starts causing problems. For younger people, the most common cause of spinal stenosis is usually explained by a genetic factor or a disease that affects bone and muscle development. The following are examples of known causes of spinal column narrowing:
- Osteoarthritis: A significant part of the reason aging leads to spinal stenosis is because of osteoarthritis, a joint disease that involves the breakdown of cartilage around bones. In some osteoarthritis patients, cartilage around the vertebrae breaks down and outgrowths called bone spurs develop in the area. Some of these can extend into the spinal canal and cause compression of spinal nerves.
- Herniated Disc: As a person ages, the shock-absorbing, cushion-like vertebral discs that separate the bones of the spinal column begin to deteriorate. In this condition, trauma or physical strain can force a disc out of alignment and put pressure on the spinal cord or other nerves.
- Thickened Ligaments: Another effect of aging is a thickening of the fibrous bands called ligaments that essentially hold bones in place. This includes the ligaments that connect the bones of the spinal column; the thicker and stiffer the ligaments get, the more likely they are to impact the spacing between the vertebrae.
- Trauma (Myelopathy): As with any part of the body, damage to the spinal column can result in localized compression of vertebral spaces and thus the symptoms of spinal stenosis.
- Tumor: While rare, it is also possible for an abnormal cellular growth to form inside the spinal canal and cause symptoms.
- Genetics: Congenital spinal stenosis is an example of a person being born with an abnormally small spinal canal. Similarly, a person with scoliosis has an abnormally shaped spine and is therefore more likely to develop spinal stenosis.
Treatment Options for Spinal Stenosis
The course of treatment a doctor can pursue will depend on the type and severity of stenosis. To determine this, a doctor will typically rely on tests like magnetic resonance imaging (MRI), X-rays, or CT scans (computed tomography, also known as a myelogram). Imaging tests will reveal the area of the spine and the nature of the problem causing the pressure, whether it be a bone spur, herniated disc, or tumor. Depending on what is found, there are several surgical and nonsurgical treatments available:
- Medication: Over-the-counter and prescription pain medications (ibuprofen and naproxen) and anti-inflammatory medications may help with easing back pain while other treatments are attempted, but they aren’t intended for long-term use.
- Physical Therapy: Spinal stenosis patients tend to become less active in an effort to avoid the pain and other related symptoms, yet this impulse can be counterproductive and actually make the symptoms worse. Sessions with a physical therapist can help the patient gain strength and endurance while working on balance and spinal stability.
- Steroid Injections: As a result of being compressed or pinched, nerve roots around the spinal cord can become irritated or swollen. Steroid injections can be used to reduce inflammation and generally provide pain relief, but they can only be used sparingly due to potential side effects of overuse.
- Decompression: Decompression is most often used for cases of spinal stenosis caused by thickened ligaments. Small and precise incisions allow the doctor to remove some of the overly thick ligament and thereby relieve some of the pressure.
- Spine Surgery: Usually one of the last resorts, surgery can physically and directly decompress the parts of the vertebral column that have developed stenosis. The laminectomy and laminotomy procedures are used to remove part of a vertebra in order to relieve pressure on the spinal cord. A laminoplasty may also be used to treat cervical stenosis and involves adding permanent metal “hardware” on the spine that prevents future compression.
When to Call a Doctor
Spinal stenosis is the kind of condition that takes years to develop, so you likely won’t suddenly notice symptoms one day. If you’re over 50 and have started noticing some of the symptoms listed above, you may want to reach out to a doctor to get checked out. At TrustCare, we want to make it as quick and easy as possible to get answers to all your healthcare questions and concerns. Stop by for a walk-in visit or consider an annual wellness exam at any of our convenient locations.