Spinal Stenosis

If you’re experiencing back or neck pain, with feelings of tingling and numbness, spinal stenosis might be to blame. A common condition in people aged 60 and older, spinal stenosis occurs when the spine narrows, pinching the nerves. This can cause no symptoms, can be a mild annoyance, or can cause serious problems that affect a person’s quality of life. The California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, and Chula Vista areas can expertly determine the cause as well as recommend treatment to help manage the pain and further narrowing. 

What is Spinal Stenosis?

Spinal stenosis is the narrowing of one or more spaces in the spinal canal. The spinal canal, which is a tunnel that runs through each vertebrae in the spine, contains the spinal column and the nerve roots that branch off of it. Any narrowing of the spinal canal can cause the spinal canal and nerves to be compressed, irritated or pinched. 

The most common two areas that are affected by spinal stenosis are the neck (cervical spinal stenosis) and the low back (lumbar spinal stenosis). This can lead to neck pain or back pain, as well as other issues, like sciatica. 

What Causes Spinal Stenosis?

Unfortunately the most common cause of spinal stenosis is unavoidable: age. While not every person will experience spinal stenosis during their lifetime, it’s estimated that 95% of people over the age of 50 will experience some form of degenerative spinal changes that leads to pain. As we age, gravity, wear and tear, and the loss of bone dentistry all lead to a stooped posture, increase chance of injury, and bones and discs shifting out of place. 

The spinal column is both a very strong and stable structure, but is also flexible and exposed to opportunities for damage. Spinal stenosis is either a congenital cause (from birth) or an acquired cause (developing after birth). While there are many different reasons a person might experience back pain, symptoms specific to spinal stenosis occur when the narrowing of the canal specifically affects the nerves and spinal cord. 

The 33 individual vertebrae provide a flexible support structure that both allows for mobility and protection of the spinal cord. The individual discs in between each vertebrae help to cushion the vertebrae and minimize impact to the spinal column from movement (walking, jumping, etc.). Since the discs are flexible, with wear and tear and time, they have the possibility of slipping out of place and impinging on the nearby nerves, causing irritation. 

Additionally, there are ligaments and muscles that help to provide support and allow the spine to move. The nerves that leave the spine travel through the muscles, skin and surrounding structure. This is why pain that begins in the nerve roots in the spine ends up affecting any lower or upper part of the body where the nerve reaches. Disc herniation, disc bulging, thickened ligaments, spinal fractures and injuries, and arthritis can all cause narrowing of the spine. 

What are the Symptoms of Spinal Stenosis?

Depending on the location and severity of a person’s spinal stenosis, pain, numbness, tingling and weakness could be felt in the neck, arms, hands, low back, legs or feet. This could ultimately lead to balancing issues, decreased function in the hands, pain that worsens when walking or standing for long periods of time, and a heavy feeling or cramping in one or both legs. 

Symptoms vary from person to person. Some patients describe that pain as a dull ache or tenderness, while others report feeling an electric-link or burning sensation. The pain might not present itself for some time as the disease progresses, and can come and go once initially felt. 

In addition to the pain sensations, another common complication of spinal stenosis is central sensitization. As spinal stenosis becomes chronic, the peripheral nervous system (PNS) and the central nervous system (CNS) become unable to accurately process stimuli, meaning that the nerves send incorrect messages to the brain and under tolerate even the lightest sensations. Sometimes nerve stimulation can even lead to bladder or bowel incontinence, weakness in the lower extremities, as well as a complete loss of sensation, which are considered medical emergencies. 

What are the Treatments for Spinal Stenosis?

The best way to begin treatment is to get a diagnosis for a trained healthcare provider, who will perform a physical exam, review the patient’s medical and family history, as well as utilize imaging techniques to determine where spinal stenosis might be occurring. The most common treatments, often used in conjunction with each other, include: 

• Exercise: in acute phases of spinal stenosis exercise has proven to provide pain relief as well as prevent the progression of the disease
• Medications: over-the-counter NSAIDs and prescription medications with pain-relieving properties including anti-seizure medication, muscle relaxants and antidepressants all help to provide pain relief and relieve inflammation
• Physical therapy: trained physical therapists can provide a healthy exercise regimen to strengthen back muscles with a goal to improve balance, flexibility and spine stability
• Alternative medicine: acupuncture, breathing techniques and meditation have all proven helpful for relieving pain and controlling stress
• Epidural steroid injections: receiving corticosteroid and anesthetic injections into the epidural space where irritated nerve roots are located helps to reduce inflammation, pain and irritation, allowing patients to more comfortably utilize physical therapy and other treatment techniques
• Percutaneous adhesiolysis: also known as the Racz procedure, this minimally-invasive procedure removes excessive scar tissue in the epidural space, which could be the cause of inflammation, irritation and pain. 
• Spinal cord stimulation: a treatment technique wherein a small electrical lead is placed in the epidural space and produces a mild tingling sensation that replaces pain sensations. The majority of patients reported lowered pain scores, a decrease in medication use, and improved quality of life.
• Surgery: when all other treatment methods have failed to provide relief, surgery might be recommended. The good news is that most patients who suffer from spinal stenosis don’t need surgery, which could include spinal fusion, laminectomy or interspinous process spacers. 

If you believe you might be living with the beginning stages of spinal stenosis and want to avoid progression, or you are suffering with chronic pain and weakness in the neck and low back and want to review treatment options, please schedule an appointment today with the California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, and Chula Vista areas.