What is spinal stenosis?

Think of the spine as a tube. Through the middle of the tube, the spinal cord descends from the brain down to the lower back. Along the way, nerve roots branch off at every vertebral level to allow the body’s sensory and motor functions. Stenosis occurs when narrowing in the tube puts pressure on the spinal cord or these nerve roots. Spinal stenosis is usually caused by degenerative changes in the spine which occur gradually over many years. For this reason, it is more common in people over age 50.

spinal inspection

Do I have spinal stenosis?

Depending on the location and severity of stenosis, you might note pain, numbness, tingling, or weakness in the feet, hands, legs, arms, back or neck. When people describe sciatica, they sometimes use words like burning, shooting, tingling and “electrical shock”. Other people note a more dull pain in the legs and calves which occurs when standing or walking, often relieved by sitting down or leaning forward over a shopping cart. We refer to this as neurogenic claudication. Both sciatica and neurogenic claudication can result from types of spinal stenosis.

Where in the spine does stenosis occur?

By far, the most common areas are the cervical spine (neck) and the lumbar spine (low back). Cervical stenosis may present with symptoms in the hands, arms, shoulder, or neck. Lumbar stenosis may present with symptoms in the feet, legs, buttock, or lower back.

How is it diagnosed?

Stenosis is best seen on lumbar MRI or a type of CT called a CT myelogram. X-rays are usually not sufficient to visualize the narrowing.

What are my treatment options?

If pain has not improved with heat/cold, over-the-counter NSAIDs/Tylenol, or physical therapy, we may recommend trying a steroid injection. This is performed in our office using live x-ray to precisely guide a needle into the epidural space. Steroid (very potent anti-inflammatory medication) is then injected to help reduce inflammation causing the pain. In addition to this therapeutic benefit, we often gain valuable diagnostic information about exactly where the pain is originating.

What other options are there?

If injections are not helping enough, or providing only short-term benefit, we may recommend decompressing the area of stenosis. In the past, this always involved surgery to “open up” the narrowed area. However, we now have an excellent intermediate option between injections and conventional spine surgery called the Vertiflex procedure.

Using a small hollow tube, we can place an interspinous spacer between lumbar vertebrae to indirectly decompress the area of narrowing. This is a minimally-invasive procedure which usually takes about 30 minutes and is performed through an incision less than 1 inch. Patients go home after about an hour in the recovery area. Click here for more information on the Vertiflex procedure.

When should I see a surgeon instead of trying injections or the Vertiflex procedure?

If your spinal stenosis is severe enough to cause weakness in the arms or legs, dropping objects from your hand, foot drop or falls from legs “giving out”, bladder dysfunction, or bowel incontinence, you should consult a neurosurgeon or an orthopedic spine surgeon. If you present to us with these types of symptoms, we will not recommend injections or the Vertiflex procedure. We will instead make the appropriate referral for surgical decompression.