Spinal Stenosis

As we age, natural changes in the spine can lead to spinal stenosis. These changes occur gradually over time and are the most common causes of the condition.

• Thickening of ligaments: The ligaments that hold the vertebrae (bones) of the spine in place can become thicker and harder with age. This can reduce the space available for the spinal cord and nerves.
• Bone growth: As bones and joints age, they may enlarge, and bone spurs (also called osteophytes) can develop. These spurs can press on the nerves or spinal cord, narrowing the spinal canal.
• Herniated discs: Discs are cushion-like pads between the vertebrae. As we age, these discs can dry out and crack, causing them to bulge and put pressure on the spinal cord or nerve roots.
• Facet joint changes: The facet joints in the back of the spine help with movement. When the spine becomes unstable, the capsules around these joints thicken, leading to bone spurs that can decrease the space around the nerves, contributing to stenosis.
• Spondylolisthesis: This occurs when one vertebra slips out of place over another, causing misalignment of the spine and pressure on the spinal cord or nerves.

Arthritis is another common cause of spinal stenosis, especially osteoarthritis and rheumatoid arthritis.

• Osteoarthritis: This is the most common type of arthritis, especially in older adults. It causes the breakdown of cartilage in joints and can lead to bone growth, narrowing the spinal canal and nerve root passages.
• Rheumatoid arthritis (RA): RA is an autoimmune disorder that causes inflammation in the joints. While it's less common for RA to lead to spinal stenosis, it can cause significant damage to the spine's joints, leading to narrowing and pressure on the spinal cord and nerves.

Some people are born with conditions that can lead to spinal stenosis, as the spinal canal may already be narrow at birth. These include:

• Congenital stenosis: This is a condition where a person is born with a naturally narrow spinal canal, making them more prone to spinal stenosis later in life.
• Scoliosis: Scoliosis is a curvature of the spine that can lead to narrowing of the spinal canal.

Several other conditions can also contribute to spinal stenosis:

• Spinal tumors: Tumors in the spine can grow into the spinal canal, causing inflammation or pressure that narrows the space and affects the spinal cord and nerves.
• Fractures: Spinal fractures, whether from trauma or conditions like osteoporosis, can lead to misalignment of the spine or create bone fragments that enter the spinal canal.
• Paget's disease of bone: This condition causes bones to grow larger and weaker than normal. As it progresses, new bone forms too quickly, causing misshapen, weak bones that can change the structure of the spinal canal and lead to stenosis.
• Ossification of the posterior longitudinal ligament: This condition occurs when calcium deposits build up on the ligament running along the back of the spine. Over time, these deposits turn the ligament into bone, which can compress the spinal cord and nerves.

Making some changes at home and adopting healthy habits can help you manage the symptoms of spinal stenosis and feel more comfortable. Here are some simple treatments you can try:

• Heat and cold therapy: Heat can help relax your muscles and ease joint pain, especially for osteoarthritis. It improves blood flow and can help with stiffness. Just be careful not to use heat that’s too hot to avoid burns.
  
  If heat isn’t helping, ice might be a better option. You can use an ice pack, frozen gel pack or even a bag of frozen peas. Apply it for 20 minutes on and 20 minutes off to help reduce swelling and inflammation.
• Exercise: Talk to your doctor before starting, but regular exercise can be helpful. It can reduce pain, strengthen muscles that support your spine and improve flexibility and balance to prevent further discomfort.
• Weight loss: Losing weight or maintaining a healthy weight can help keep pressure off your spine. In addition, using a walker or other assistive device if you have trouble walking can help you remain stable.

Your doctor may recommend over-the-counter or prescription medications that can help control symptoms. Spinal stenosis medication might include:

• Anti-inflammatory medicines: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen sodium can relieve inflammation that causes pain in the spine.
• Epidural spinal injections: Doctors inject medicine directly into the space surrounding your spinal cord or nerves to help relieve symptoms.
• Pain relievers: Over-the-counter medicines or prescription pain relievers can help control back and neck pain. Some can be applied directly to the skin.
• Neuromodulatory medications: Medicines such as gabapentin or pregabalin are useful in treating the symptoms of sciatica (medically known as radiculopathy) that results from spinal stenosis.

Physical therapy and bracing are effective treatments that can help manage spinal stenosis and improve your daily movement. These methods focus on strengthening your body, improving posture and reducing pressure on the spine.

• Physical therapy: A physical therapist will work with you to create an exercise plan that strengthens your back and core muscles. This can help make your spine more stable and reduce discomfort. They will also teach you ways to improve your balance and flexibility. One key part of therapy may include teaching you how to walk in a way that eases pressure on your nerves.
• Bracing: For lumbar spinal stenosis, wearing a brace can help reduce pressure on your lower spine and limit small movements that may irritate the nerves. Sometimes, a brace can also help improve your posture or shift weight to your abdomen, taking pressure off your spine and providing relief from pain.

Integrative medicine focuses on combining traditional treatments with alternative therapies to manage spinal stenosis symptoms and improve overall well-being. These options can be used alongside other treatments to help reduce pain and promote healing.

• Acupuncture: Acupuncture may help alleviate pain in some cases of lumbar stenosis, especially for less severe symptoms. It involves inserting thin needles into specific points on the body to improve energy flow and reduce pain.
• Chiropractic manipulation: Chiropractic manipulation can be a helpful treatment for spinal stenosis pain by improving spinal alignment and mobility. It’s generally safe for most people, but caution is needed if you have conditions like osteoporosis or a herniated disc, as manipulation may worsen symptoms or cause injury in these cases.
• Massage therapy: Massage therapy can provide relief by easing muscle tension and improving blood flow to the affected areas. Regular sessions may help reduce pain, improve flexibility and promote relaxation. It’s a gentle, noninvasive option that can complement other treatments to manage spinal stenosis symptoms effectively.

If treatments like medications and lifestyle changes don’t relieve your symptoms or if your condition gets worse, surgery might be considered. In some cases, if your symptoms are severe, your doctor may recommend surgery sooner. The main goal of surgery is to relieve pressure on the spinal cord (or nerves) that is causing your pain and other symptoms.

There are different surgical options for spinal stenosis, depending on the severity of your condition and which part of the spine is affected:

• Discectomy: If you have a herniated (slipped) disc that’s pressing on nerves, a discectomy may be recommended. This surgery removes part or all of the damaged disc to relieve pressure on the nerves in the neck (cervical) or lower back (lumbar).
• Foraminotomy: This surgery creates more space in the spine where nerve roots exit. By widening these openings, pressure on the nerves is relieved, which can help reduce pain and improve mobility.
• Laminectomy: In a laminectomy, the surgeon removes part of the vertebrae, such as bone spurs, to widen the spinal canal. This creates more space for the spinal cord and nerves, easing pressure and reducing pain.
• Spinal fusion: If there’s instability in the spine, a spinal fusion might be necessary. This surgery fuses two or more vertebrae together to stop movement between them, helping to provide stability and prevent further issues.

Your doctor will discuss the best option for you based on your symptoms, the severity of your condition, and your overall health.