Spinal Stenosis: Symptoms, Diagnosis, and Surgical Treatment
Spinal stenosis is a narrowing of the spinal canal that houses the spinal cord and nerve roots. This condition most commonly develops after age 50 and is one of the leading causes of back pain in older adults.
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What is spinal stenosis
The spinal canal is a bony tunnel that protects the spinal cord. In stenosis, the canal narrows due to thickened ligaments, bone spur growth, or disc protrusions, compressing the neural structures and causing pain and dysfunction.
Causes
- Degenerative spinal changes (osteoarthritis)
- Hypertrophy of the ligamentum flavum
- Herniated intervertebral discs
- Spondylolisthesis (vertebral slippage)
- Congenital narrowing of the spinal canal
- Post-traumatic spinal changes
Symptoms
- Lower back and leg pain during walking
- Neurogenic claudication: needing to stop and sit every 100-200 meters
- Numbness and weakness in the legs
- Relief when leaning forward (the shopping cart sign)
Neurogenic claudication is the hallmark symptom of spinal stenosis. If you notice that the distance you can walk without stopping is decreasing, do not delay seeing a specialist. Without treatment it can keep getting worse.
Diagnosis
The primary diagnostic tool is lumbar MRI, which reveals the degree of canal narrowing. X-rays and CT scans provide additional detail on bony structures. Electromyography (EMG) helps assess the extent of nerve involvement.
Minimally invasive surgical techniques allow decompression through incisions less than 2 cm, which shortens recovery compared with open surgery.
Treatment options
Conservative treatment
In early stages, treatment includes anti-inflammatory medications, physical therapy, and epidural steroid injections. Targeted exercises focus on strengthening the back muscles and improving posture.
Laminectomy
The classic decompressive procedure involves removing a portion of the vertebral arch to widen the canal. It is particularly effective for multilevel stenosis.
Foraminotomy
This procedure widens the neural foramen, the opening through which nerve roots exit the spine. It is used for localized foraminal stenosis and can be performed endoscopically.
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