Spinal stenosis is characterized by abnormal narrowing in the spinal canal. This narrowing may be caused by mechanical problems or by abnormalities in the aging spine. It may or may not result in low-back pain, limping, and a lack of feeling in the legs. Stenosis is often a degenerative condition. It may exist for years without causing pain or discomfort, but a fall or an accident can trigger characteristic pain.
Numerous factors can cause stenosis, such as thickened ligaments, expanding infection, abscess, a congenital or developmental anomaly, degenerative changes, vertebral fractures or dislocations, or a spinal cord tumor. Other conditions, such as a herniated disc, can mimic stenosis. While herniated discs usually cause a muscle spasm to come on rapidly and painfully, discomfort caused by stenosis builds gradually. Other conditions that can beconfused with stenosis include vascular claudication, peripheral vascular disease, and abdominal aortic aneurysms.
Claudication is the pain, aching or fatigue of the muscles of the buttocks, thigh and/or calf that occurs with exertion. It is caused by vascular disease and most often occurs after walking a fixed distance. Patients with spinal stenosis, however, walk much greater distances before symptoms set in. Activities like riding a bicycle and walking up a hill can cause pain in patients with vascular claudication, but not in those with stenosis. Conversely, standing makes pain worse for patients with stenosis, while it relieves vascular claudication.
How is stenosis treated?
There are four basic treatment approaches to spinal stenosis:
- Conservative measures that include bed rest, analgesics, local heat, and exercise
- Chiropractic, which includes manipulation, muscle therapy, and self-care techniques
- Epidural steroid injections for temporary relief
- Invasive surgery
The source of the stenosis often dictates the treatment. Although medications can provide pain relief, those powerful enough to deaden the pain can also exacerbate patients’ already compromised sense of balance. When the patient loses bowel or bladder control, suffers from intolerable leg pain and claudication, and has progressive loss of function or spinal cord tumors, surgery is the first and only option.
The standard stenosis surgical procedure usually involves opening up the spinal canal and decompressing the neural elements by removing the bony structures that contribute to canal narrowing. Although many patients do fairly well after the surgery, the symptoms are likely to return after a period of time. Recent studies show that although stenosis surgery will often have good results up to two years, in the long run, outcomes are much the same between surgery and conservative care. Some surgeries have to be repeated years later.
Many are far from fully satisfactory. Surgery is a complicated procedure that irreversibly changes the structure of the back. In many mild and moderate cases of stenosis, however, non-invasive conservative care, such as chiropractic, can help lessen pain and discomfort, maintain joint mobility, and allow the patient to keep a reasonable lifestyle. A technique called distraction manipulation may be helpful in reducing leg discomfort.
Home exercises are a major part of the conservative treatment program. It is recommended to exercise four or five times a week with physical activities such as riding on the bicycle or lying on the side and grasping the knees with the arms, focus on flexing the spine in a forward position—stretching and strengthening the lower back and stomach muscles and improving muscle strength.
Exercises designed to mobilize the involved nerves have been found to be particularly helpful. Ultimately, stenosis is a chronic condition that currently has no cure, but it often can be improved. Patients can work with a doctor of chiropractic to reduce symptoms and improve their quality of life.