Spinal stenosis Health Article

Definition

Spinal stenosis is a narrowing of areas in the lumbar (back) or cervical (neck) spine, which causes pressure on the spinal cord or one or more of the spinal nerves.

Alternative Names

Pseudo-claudication; Central spinal stenosis; Foraminal spinal stenosis

Causes, incidence, and risk factors

Spinal stenosis may be caused by:

• Arthritis involving the spine, usually in middle-aged or elderly people
• Herniated or slipped disk
• Injury that causes pressure on the nerve roots or the spinal cord itself
• Defect in the spine that was present from birth (congenital defect)
• Tumors in the spine
• Paget's disease of bone
• Achondroplasia

Symptoms

Often, symptoms will be present and gradually worsen over time. Most often, symptoms will be on one side of the body or the other.

• Numbness, cramping, or pain in the back, buttocks, thighs, or calves, or in the neck, shoulders, or arms
• Weakness of a portion of a leg or arm

Symptoms are more likely to be present or get worse when you stand or walk upright. They will often lessen or disappear when you sit down or lean forward. Most people with spinal stenosis cannot walk for a long period of time.

More serious symptoms include:

• Difficulty or imbalance when walking
• Problems controlling urine or bowel movements
• Problems urinating or having a bowel movement

Signs and tests

During the physical exam, your doctor will try to pinpoint the location of the pain and figure out how it affects your movement. You will be asked to:

• Sit, stand, and walk. While you walk, your doctor may ask you to try walking on your toes and then your heels.
• Bend forward, backward, and sideways.
• Lift your legs straight up while lying down. If the pain is worse when you do this, you may have sciatica, especially if you also feel numbness or tingling in one of your legs.

Your doctor will also move your legs in different positions, including bending and straightening your knees. All the while, the doctor is assessing your strength, as well as your ability to move.

To test nerve function, the doctor will use a rubber hammer to check your reflexes. Touching your legs in many locations with a pin, cotton swab, or feather tests your sensory nervous system (how well you feel). Your doctor will instruct you to speak up if there are areas where the sensation from the pin, cotton, or feather is duller.

A brain/nervous system (neurological) examination can confirm leg weakness and decreased sensation in the legs. The following tests may be done:

• EMG
• Spinal MRI or spinal CT scan
• X-ray of the spine