The spinal canal contains the spinal cord and spinal nerves which run from the brain down to the body. It is formed by the spinal bones (vertebra/vertebrae), intervertebral discs and ligaments. At each spinal level, two holes (foramen/foramina) allow a pair of spinal nerves to exit the spinal canal. Narrowing of the spinal canal or foramina is termed spinal stenosis. Spinal stenosis can affect any part of the spine however the lumbar (lower back) and cervical (neck) areas of the spine are the most commonly affected. Spinal stenosis can compress the spinal cord and nerves which can lead to pain, numbness and weakness in your legs or hips (lumbar stenosis) or neck and shoulders (cervical stenosis).
Spinal stenosis is most common in people over the age of fifty. It is usually the result of age-related wear and tear (arthritis) in the spine, disc herniation or a combination of both. This can be exacerbated by trauma. It can also be seen with spondylolisthesis when one vertebra has slipped forwards or backwards in relation to another. More rarely, spinal stenosis can occur secondary to infection or tumours.
Cervical stenosis
Symptoms of cervical stenosis include:
- pain in the neck and shoulders which may radiate down your arms and/or into your hands;
- numbness and/or pins and needles and/or other sensory disturbance in the arms or hands;
- headache;
- weakness in the arms or hands;
- clumsiness and difficult with fine motor control e.g. doing up buttons;
- unsteadiness/falls;
- stiffness and/or weakness in the legs.
Symptoms of cervical canal stenosis often increase with time in a progressive stepwise manner.
If you have new weakness in your arms and/or legs, clumsiness/difficulty with fine motor control, and/or unsteadiness/falls you should seek immediate medical attention.
Lumbar stenosis
One of the most common symptoms of lumbar canal stenosis is neurogenic claudication: pain or weakness in one or both buttocks or legs after walking or standing for any length of time.
Other symptoms of lumbar stenosis include:
- pain in the lower back or buttocks which may radiate down your legs and/or into your feet;
- numbness and/or pins and needles and/or other sensory disturbance in the legs or feet;
- weakness in the legs or feet;
- numbness or sensory disturbance affecting the groin, perineum and genital region;
- change in bladder or bowel function.
If you have new pain in both legs or weakness in your legs or feet, numbness in your buttocks or perineum (groin), or a change in bladder and bowel function you should seek immediate medical attention.
To confirm a diagnosis, Dr Laban will take your medical history and will do a physical examination as indicated and usually recommend an MRI scan and possibly other further investigations such as a SPECT-CT bone scan and / or electrophysiological tests.
Treatment
Conservative treatment may be suggested initially depending on your symptoms and medical history. This might include:
- pain relief: using over the counter painkillers and anti-inflammatory medication such as paracetamol or ibuprofen or specific nerve pain relief such as pregabalin or amitriptyline;
- CT-guided injections (typically with a combination of local anaesthetic and steroid);
- remaining active including walking, stretching, swimming, yoga and Pilates;
- optimising your weight and diet.
If symptoms do not improve or if you have significant pain or neurological deficit, surgery may be an option. In some cases, surgery is the safest option. The goal of the operation is to relieve pressure on the affected nerves and in doing so cure, improve or prevent symptoms. There are a number of different ways this decompression may be done which include a laminectomy, foraminotomy or microdiscectomy. Sometimes fusion is also indicated e.g. anterior cervical discectomy, posterior cervical fusion and posterior lumbar interbody fusion. Some procedures can be done using minimally invasive techniques which may result in shorter hospital stays and speedier recovery.
Spinal Stenosis Specialist
Dr Laban is a specialist spine surgeon who deals with all types of back pain related problems and conditions including spinal stenosis. If you are experiencing any of these symptoms, contact us today to book an appointment and get the diagnosis and help you need.
