1/19/07

Spinal Stenosis
By: Vallie Rogers, PT, Dip. MDT

Odds are you will experience back pain at some point in your life. If you are over 50 years of age and have arthritis there is a chance that it could be caused by “spinal stenosis.” Often when evaluating patients in the clinic who are middle-aged or older, spinal stenosis is at least one of the components of why the patient needs therapy. Stenosis means narrowing. This narrowing is most commonly caused by changes in the spine that come with aging and osteoarthritis. In a few cases it is the result of a tumor, trauma, or other medical condition.

As people age spinal structures begin to degenerate. For most, the changes are minor and do not cause problems. For others, the cushioning discs may break down while the bones and joints of the spine enlarge. Ligaments may harden and bone spurs may develop. These changes can lead to narrowing of the spinal canal and pressure on the spinal cord and/or nerve roots exiting the spine.

The part of the spine most affected is the lumbar region, or low back. The first symptom is usually pain in the lower back. Several months or even years later, the pain may begin to radiate into the legs. Symptoms may also include numbness, weakness, or cramping in legs with walking and standing. Typically, symptoms are relieved by sitting or bending forward because these positions increase the space available in the spinal canal, potentially lessoning the pressure on the spinal cord and/or nerve roots. In more severe cases, people may have trouble walking and may adopt a stooped posture to relieve symptoms. With both cervical and lumbar stenosis, part of the spinal cord can become compressed resulting in loss of bowel or bladder control and sexual dysfunction. With cervical stenosis, people may have pain, numbness or weakness in one or both arms as well as a loss of hand coordination.

Diagnosing spinal stenosis can be challenging, especially in the early stages. A physical examination, x-ray, and imaging tests may be used to confirm diagnosis. Once spinal stenosis is diagnosed, the next step is management and treatment of the condition. Non-surgical options would include: anti-inflammatory medications; physical therapy to strengthen the back muscles, improve posture and maintain movement of the spine; aerobic exercise to increase endurance and improve blood supply; or bracing to provide additional support.

For more serious episodes of pain epidural injections may be of benefit. When non-surgical measures no longer provide lasting pain relief, surgical intervention may be the only option.

Surgery’s goal is to reduce the pressure by “opening up” the spinal canal. The most common procedure is a decompressive laminectomy which involves removing part of the bony structures. When instability is present, a spinal fusion may be more appropriate. This involves fusing two or more vertebra together to limit motion. Most people will require physical therapy for a period of time following surgery to restore function, mobility and strength.

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