The two types of spinal stenosis are lumbar stenosis and cervical stenosis. Lumbar spinal stenosis is the more common of the two, but cervical spinal stenosis is often more dangerous since it involves compression of the spinal cord.
Comparing Lumbar Spinal Stenosis and Cervical Spinal Stenosis
- The spinal nerve roots in the lower back of a patient with lumbar stenosis are compressed (choked). This often produces symptoms of sciatica. Sciatica is a pain that originates along the sciatic nerve, which extends from the back of the pelvis down the back of the thigh.
- Cervical spinal stenosis is the name for spinal stenosis in the neck. It can be far more dangerous by compressing the spinal cord. The condition may lead to serious symptoms, which can include major body weakness or paralysis.
In rare cases, lumbar stenosis only produces leg pain that is severe, persistent and disabling, in addition to leg weakness. Most cases of lumbar stenosis, however, involve pain radiating into the leg(s) when a patient walks, and is relieved when the patient sits. This condition, called claudication, also can be caused by problems with circulation in the legs.
Spinal Stenosis Pain in Older Patients
Most spinal stenosis patients first visit their doctor to report symptoms at around age 60. This spine condition is related to degeneration in the spine. Patients with spinal stenosis should seek treatment if the activity limitations associated with the condition are no longer tolerable. This could include leg pain or difficulty walking.
Around three-fourths of spinal stenosis cases occur in the low back, which is called lumbar spinal stenosis. Most cases affect the sciatic nerve, which runs along the back of the leg. Sciatica is the common name for this spinal stenosis symptom.
Spinal Stenosis Symptoms and Diagnosis
Sciatic (leg pain) is among the most common symptoms of lumbar spinal stenosis. It may be accompanied by low back pain, leg tingling or numbness and/or walking limitations.
Common Symptoms of Spinal Stenosis
Leg pain associated with walking is also known as claudication. It can be caused by arterial circulatory insufficiency (known as vascular claudication) or spinal stenosis (known as neurogenic or pseudo-claudication). Patients with either condition will generally see the leg pain go away with rest, but spinal stenosis patients usually must sit for a few minutes to ease the leg pain and often the accompanying low back pain. Vascular claudication will dissipate simply if the patient stops walking.
Leg pain and stenosis symptoms generally develop over several years, but they can come on acutely as well. The pain worsens the longer the patient stands or walks. Pain is relieved by flexing forward or sitting because this opens the spinal canal.
True weakness is a rare spinal stenosis symptom, though some numbness and tingling can come along with the pain. Numbness and tingling can accompany the pain, but true weakness is a rare symptom of spinal stenosis.
Overview of Lumbar Spinal Stenosis Symptoms
General characteristics of lumbar spinal stenosis symptoms include:
- gradual development over time
- non-continuous pain that comes and goes
- occurring during specific activities like walking) and/or in positions like standing upright
- relieved by rest, whether sitting or lying down and/or getting into any flexed forward position
Spinal Stenosis Diagnosis
MRI scans and CT scans with myelogram are two diagnostic imaging studies for patients with cervical stenosis or lumbar stenosis. A CT scan with myelogram uses an x-ray dye in the spinal sack fluid. Sometimes both tests are used.
These tests can show the changing (dynamic) effect each form of spinal stenosis has on nerve compression, including when bearing weight. This changing compression means spinal stenosis symptoms vary, meaning the physical examination generally will not show any motor weakness or neurological deficits. Some methods allow scans to be conducted while the patient is standing upright to study spinal loading effects.
Spinal Stenosis Treatment
Spinal stenosis can often be managed non-surgically, depending on the severity of the patient's symptoms.
Non-surgical Treatment for Spinal Stenosis
Options available for non-surgical spinal stenosis treatment may include:
- Exercise . While not curative, exercises conducted under the supervision of a trained physical therapist may be helpful for spinal stenosis patients. Exercise is an important part of any treatment program since remaining active as tolerable will prevent the patient from becoming additionally debilitated.
- Activity modification . Patients may be counseled to avoid activities that bring about spinal stenosis symptoms. Part of the recommendation may be to incorporate flexing forward in certain activities, as patients are generally more comfortable in this position. This might include leaning on a walker or shopping cart instead of walking upright, leaning forward on the handlebars while on a stationary bicycle instead of walking for exercise; sitting in a recliner instead of on a chair with a straight back.
- Epidural injections . Temporary relief of spinal stenosis symptoms may be achieved through a cortisone injection in the space outside the dura (the epidural space). Injections can seldom be considered curative, but these spinal stenosis treatments can alleviate the pain in around half of cases. Though injections themselves are not diagnostic, generally, if the spinal stenosis pain is by an epidural steroid injection, the patient is likely to have a good result if they later choose surgical intervention.
Additional Treatments for Spinal Stenosis
Anti-inflammatory medication, such as aspirin or ibuprofen, may be helpful in treating spinal stenosis.
For some patients, non-surgical therapies may manage spinal stenosis symptoms effectively for a period of time or even indefinitely. The decision of whether or not to have surgery is largely dependent upon the degree of physical disability and disabling pain from lumbar spinal stenosis.
When the (usually elderly) patient can no longer walk sufficiently to care for himself, then lumbar spinal stenosis surgery is usually recommended. Surgery is mainly designed to increase a patient's ability to do more with less pain.
Spinal Stenosis Surgery
Decompression surgery for spinal stenosis is required in most cases involving advanced claudication (spinal or vascular). Most patients do well after decompression surgery and are able to increase their activity following recovery, including better walking tolerance.