August 2003 Bulletin

Spinal stenosis

Patient Information from Your Orthopaedic Connection

Back aches and pains are a health concern for millions of people. In fact, nearly 26 million visits were made to physicians' offices due to back problems in the year 2000, including 7 million visits for low back problems. The symptoms come in different forms, but one of the most common causes for the problem is spinal stenosis.

Stenosis means narrowing. In spinal stenosis, the spinal canal, which contains and protects the spinal cord and nerve roots, narrows and pinches or irritates the spinal cord and/or nerves that enter or leave the spinal cord. This narrowing can be caused by a bulging or herniated disk in the spinal column. The result is low back pain. You can also experience pain or numbness in the legs, muscle weakness or changes in leg reflexes.

Causes of spinal stenosis

There are many potential causes for spinal stenosis, including:

Symptoms of spinal stenosis

Diagnosing spinal stenosis

Because these symptoms can be caused by many other conditions, spinal stenosis may be difficult to diagnose. There is usually no history of back problems or any recent injury. Often, unusual leg symptoms are a clue to the presence of spinal stenosis.

If simple treatments, such as postural changes, nonsteroidal anti-inflammatory drugs or physical therapy do not relieve the problem, your orthopaedic surgeon may request special imaging studies to determine the cause of the problem. An MRI (magnetic resonance image) provides details about the bones, tissues and narrowing of the spinal canal. A CT (computed tomography) scan with intrathecal contrast may be done if the patient cannot undergo MRI because of implanted devices such as a pacemaker. A myelogram (an X-ray taken after a special fluid is injected into the spine) may also be arranged.

Treatment

Conservative treatment options include:

When stenosis causes severe nerve root compression, these treatments may not be enough. Back and leg pain may return again and again. Because many stenosis sufferers are unable to walk even short distances or have difficulty standing they often confine themselves to the home.

If conservative treatment does not relieve the pain, your orthopaedic surgeon may recommend surgery to relieve the pressure on affected nerves. In properly selected cases, the results are quite satisfactory, and patients are able to resume a normal lifestyle.


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