Stenosis Specialist

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Definition: Stenosis (narrowing of the spinal canal) due to genetics (congenital stensosis) or from arthritis, bone spurs and disc degeneration (degenerative stenosis). Degenerative stenosis is much more common that congenital stenosis.

Some people are born with a congenital form, but most develop spinal stenosis as part of the degenerative cascade. A few do not feel any effects of the narrowing, but as part of the aging process, most people will eventually notice radiating pain, weakness, and/or numbness secondary to the compression of the nerves or spinal cord.

While the narrowing may occur at different parts of the spine, the symptoms of nerve compression are often similar. That is why specialists often will perform testing to determine the cause and location of the narrowing.

See Radiculopathy

What is cervical stenosis?

The term "stenosis" comes from the Greek word meaning "choking" or narrowing of the spinal canal. The spinal canal is the open area in the bones (vertebrae) that make up the spinal column. The spinal cord is a collection of nerves that runs through the spinal canal from the base of the brain to the lower back. In cervical spinal stenosis, the spinal canal narrows and can squeeze and compress the nerve roots where they leave the spinal cord or it may compress or damage the spinal cord itself. The seven vertebrae between the head and the chest make up the cervical spine. Squeezing the nerves and cord in the cervical spine can change how the spinal cord functions and cause pain, stiffness, numbness, or weakness in the neck, arms, and legs. It can also affect your control of your bowels and bladder.

What are the symptoms for cervical stenosis?

Many people have some narrowing of the spinal canal but do not have symptoms. Cervical spinal stenosis does not cause symptoms unless the spinal cord or nerves becomes squeezed. Symptoms usually develop gradually over a long period of time and may include:

Symptoms of Cervical stenosis

•Pain in the arm in a specific nerve distribution (radiculopathy)

•Neck pain

•Weakness of the arm, generalized or specific

•Balance and coordination problems, such as shuffling or tripping while walking. Cervical spinal stenosis can be crippling if the spinal cord is damaged.

•Loss of bowel or bladder control (incontinence).

Decreased coordination or weakness of hands (especially hand grip strength), numbness/tingling of arms and hands, loss of balance, change in gait pattern, change in bladder/bowel habits. These symptoms are called cervical myelopathy and require an urgent evaluation.

What is lumbar stenosis?

Symptoms of Lumbar stenosis

•Pain in the leg in a specific nerve distribution (radiculopathy)

•Lower back pain

•Pain radiating to the hips and buttocks

•Pain when standing/ walking that is relieved by sitting (neurogenic claudication).

•Weakness of the leg(s)

•Loss of bladder and bowel control in more severe cases

As lumbar spinal stenosis symptoms worsen, they may become quite debilitating.

What are the treatment options for stenosis?

Non-operative:

Medications (preferably anti-inflammatory medications) can help control pain,. Physical therapy can help strengthen musculature surrounding spine for stability.  Epidural steroid injections can help decrease inflammatory response and decrease pain.

Operative: 

Surgical treatment of stenosis requires decompression of the nerve(s) or root(s) affected. This can be done by laminectomy (traditional method) or laminotomy/ foraminotomy (minimally invasive technique) depending on the area of stenosis.  If instability of the spine is noted (spondylolisthesis) or if stenosis is so severe that the facets need to be removed, then a fusion procedure may be required as well.