Chronic and acute neck and low back pain are major healthcare issues in the U.S. At least 80% of the population will experience back pain at some point in their lives.
When spinal narrowing (also called spinal stenosis) occurs, the spinal canal becomes narrower and impinges on the spinal cord (central stenosis) or on the nerve roots as they leave the spine (foraminal stenosis). Spinal narrowing occurs most often in the lumbar spine and the cervical spine. Although it can occur in the thoracic spine, this is rare.
The spinal cord and the brain stem comprise the central nervous system and are responsible for gathering and processing sensory information. The spinal column is made up of 34 bones: 24 are articulated vertebrae and 10 are the naturally fused vertebra of the sacrum and coccyx.
Each vertebra consists of a vertebral arch and a large, cylinder-shaped body. The arch is made up of the spinous process and a facet joint on each side. It is the facet joint that allows your spine to flex and bend. Cartilage and discs, as well as soft tissue, such as muscles and ligaments, are attached to various parts of the vertebrae.
The space created by the arch and the vertebral body is the spinal canal. The spinal canal houses your spinal cord. In addition, there are other openings on the vertebrae called the foramina (singular foramen) that allow the nerve roots to pass through the spinal column. At each level of the spine, a pair of spinal nerves exit the vertebral column via these small openings.
What is Spinal Narrowing?
Spinal narrowing – also called spinal stenosis – refers to the narrowing of the bone channel occupied by the spinal nerves or spinal canal. Although the narrowing can occur at different parts of the spine, the symptoms of nerve pressure are often similar.
Causes of Spinal Narrowing
The main cause of spinal narrowing is natural wear and tear due to age. This wear and tear causes abnormalities to form, such as bone spurs, herniated or bulging discs, and arthritic joints, to name just a few. While these developments are not uncommon, they can progress to the point where they compress the spinal nerves as they exit the spinal canal. When this spinal narrowing causes nerve compression, symptoms will arise.
Although degenerative disc disease due to aging is the main cause of spinal narrowing, it can also be caused by tumors, spine injuries or trauma, metabolic condition, or, rare cases, in individuals who were born with a spinal canal that is narrower than normal. Once the spine becomes so narrow that it impinges the nerve, the symptoms associated with spinal narrowing occur.
While everyone’s spine will change as they age, the severity of the symptoms depends on the size of the individual’s spinal canal and the compression on the nerves. The deterioration rate is different for everyone, and not everyone will feel pain or weakness.
Cauda equina syndrome is a rare but serious condition that is caused by compression of the cauda equina, which is a bundle of nerve roots at the bottom of the spinal cord, Fast treatment is essential for preventing lasting damage leading to incontinence and possible permanent paralysis. This is a medical emergency that requires a surgical intervention.
Symptoms of Spinal Narrowing
When spinal narrowing compresses a nerve, symptoms occur in the area of your body that is innervated by the pinched nerve. As an example, a compressed nerve in the cervical spine will affect the neck, shoulders, arms, hands and/or fingers, while a pinched lumbar nerve will affect the lower back, hips, buttocks, thighs, calves and/or feet. Thoracic spinal stenosis occurs rarely and can cause pain in the ribs and in one or more internal organs as well as the general symptoms listed below.
• Mild to severe pain in the lower back
• Pain in the buttocks, thigh, or leg that worsens while walking and lessens with rest
• Numbness, tingling, and weakness in the lower extremities
Diagnosing Spinal Narrowing
In order to diagnose the cause of back pain and sciatica, your physician will take a detailed medical history and perform a physical examination. Your doctor will evaluate your symptoms, what makes them better or worse, and how long you’ve had them.
A physical examination helps determine how severe the condition is, and where it may be causing numbness or weakness in the body. A neurological examination will find abnormalities in the sensation and strength of specific parts of the body that can provide objective evidence of chronic nerve root compression due to spinal narrowing. An x-ray, MRI, or CT scan may be used to assess the degree of narrowing and confirm the diagnosis.
Treatment for Spinal Narrowing
Treatments for spinal narrowing vary depending on the severity of the symptoms and how much they affect your daily life. Every patient is different and not all treatments work for all patients.
There is a wide range of conventional, non-surgical treatment options for the symptoms of spinal narrowing, such as:
• Exercises to strengthen the muscles that help support the spine
• Physical therapy
• Epidural injections of cortisone
• Pain medication such as over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) or prescription pain medication
• Hot/cold therapy
• Lifestyle changes
Once conventional, non-surgical treatment options have been exhausted, your physician may suggest a consultation with a spine surgeon to discuss your surgical options. Surgical options may include:
• Foraminotomy / Foraminectomy
• Laminectomy / Laminotomy
• Facet Thermal Ablation
Prevention & Self-Care
Prevention and self-care can help preserve and enhance your spine health. Consider implementing the following habits:
• Stop smoking and reduce alcohol consumption
• Stay hydrated
• Regular exercise
• Healthy diet
• Maintain proper posture when standing and sitting
• Maintain a healthy weight