Severe spinal stenosis symptoms are not very common. Usually the symptoms are mild to moderate, but they can affect both the lower back and legs. If you are suffering with severe back pain, there are probably other problems on top of any spinal stenosis that might be present. Treatment for spinal stenosis in most cases can only offer a temporary fix, and it really depends on the underlying cause as to how effective any treatment will be. Read on to find out why.
What is Spinal Stenosis?
Spinal stenosis occurs when the spinal openings or canals for the nervous system become narrowed. This can either affect the central spinal canal, where the spinal cord descends from the brain, or more commonly it will occur where the spinal nerves exit from the spine. This canal where the nerves exit from the spine is called the neural foramen.
Because the spinal cord and nerves are totally encased by bone, if the Central Spinal Canal or the Neural Foramen become too narrow, the bone can start to compress the nerves.
Central canal stenosis symptoms are rare, as it needs to be moderate to severe narrowing before it will compress the spinal cord.
Most commonly it is foraminal stenosis that causes problems as the bone encroaches on the spinal nerve.
What Causes Spinal Stenosis?
There several different causes that can lead to narrowing of the spinal canals.
- Spinal Degeneration. Most cases of spinal stenosis are a result of degenerative changes as we get older. This is basically a result of wear and tear of the spinal structures. Degenerative disc disease decreases the space between the vertebra, therefore narrowing the neural foramen. Formation of bone spurs (particularly around facet joints) can grow into the spinal canal, encroaching on the nerves.
- Herniated or Bulging Discs. If the disc is pushing into the spinal canal or neural foramen, it can create nerve pressure and irritation. Read more about the discs here.
- Hereditary. Some people are born with a smaller spinal canal. This may cause symptoms from an early age, but more likely just makes you more susceptible as you age.
- Spondylolisthesis. This condition occurs when one vertebra slips forward on the one below. This can be the result of degenerative changes or an injury. The forward slippage can create a narrowing of the spinal canals.
- Tumours. Although not common, abnormal growths can invade the spinal canals, creating spinal stenosis.
Spinal Stenosis Symptoms.
Spinal stenosis can cause lower back pain as well as pain in the legs. Leg pain can be cramping, achy, or even like sciatica. It is often aggravated by extended periods of activity, such as walking or standing.
Lumbar nerve compression from stenosis can affect the nerves that control muscle power and sensation in the legs.
This can lead to weakness, tingling or numbness. In severe cases it can even effect bowel and bladder function. This requires immediate medical attention.
The symptoms of spinal stenosis can often be relieved bending forwards. This helps to open up the spinal canals and reduce nerve pressure. Sufferers will often need to sit for a few minutes if they have been walking or standing for a while.
Lumbar spinal stenosis symptoms are also medically known as 'neural claudication'. This means leg pain when walking, and can also be caused by vascular insufficiency (problems with the blood circulation). It is important to get a correct diagnosis if you have claudication. But as a general idea, stenosis pain can be worse when walking down hill, but not as bad going up hill (as you lean forwards slightly, decompressing the nerves!) Vascular claudication is often worse going up hill as it requires more exertion.
Treatment For Spinal Stenosis.
Although there is no cure as such for spinal stenosis, the following treatments are the most common. Depending on the severity and site, one of the following options can be considered.
- Medications. NSAID's (non-steroidal anti-inflammatory) drugs, painkillers and muscle relaxants are often prescribed for spinal stenosis. They may help to temporarily relieve the pain, but do not correct the cause and carry side effects.
- Injections. Cortico-steroids may be injected to reduce inflammation and reduce nerve pressure around the swollen and irritated nerves. See above.
- Surgery. Surgery may be considered if more conservative treatments haven't helped or if you're disabled by your symptoms. The goal is to relieve the pressure on your spinal cord or nerve roots by creating more space within the spinal canal. Most commonly a Laminectomy, which is where the posterior, or back, part of the spine is removed to allow more space for the nerves. Often the affected vertebra will also be fused to the vertebra on either side.
- Activity Modification. For most spinal stenosis cases, the pain is relieved when bending forwards, and aggravated when bending backwards. Being aware of this allows you to modify your behaviours and avoid activities that cause pain, for example working over head such as hanging out washing. Diet and nutrition also play a roll. Maintaining a healthy weight means less stress and strain on the spine, and overweight people tend to have to lean backwards slightly which can increase nerve compression.
- Exercise and Physical Therapy. Activity can aggravate spinal stenosis, so it is common that sufferers will become less active to reduce their pain. This can lead to muscle weakness and further spinal instability. So it is important to maintain a reasonable level of exercise to maintain strength and fitness. An exercise program such as Total Back Pain Solution, which is designed specifically to improve long term spinal stability, is of the most benefit.
This exercise is well known to relieve the symptoms of spinal stenosis because it opens up the spinal canal space. Start by lying on your back, them simply pull both of your knees to your chest and hold them there for 10-30 seconds. This brings your spine into a flexed posture and widens the space for the nerves. Easy and effective!
This simple treatment for spinal stenosis can give quick relief from back pain, even if you have severe spinal stenosis symptoms. But the real key is working towards improving your spinal control and stability.
Always seek professional advice when suffering from back pain, as there are many different causes. Mostly these will be a mechanical problem (read more here), but can sometimes be the sign of something more sinister.
Fortunately, many people successfully manage the symptoms of spinal stenosis with the non-surgical therapies. For others, symptoms may become disabling and surgery may be considered.
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