Spinal Stenosis of the Back and Leg
Spinal stenosis can typically be treated with non-surgical or minimally invasive surgical techniques.
The word “stenosis” comes from a Greek word meaning “narrowing.” Stenosis in the spine refers to abnormal narrowing where nerves live, such as the spinal canal (the main opening in the spine containing the spinal cord and nerves) and foramen (the window where the nerves exit). When stenosis occurs in the back, it can lead to compression of nerves causing pain, weakness, numbness and tingling.
What causes spinal stenosis?
You can develop spinal stenosis in many different ways. If the narrowing is present at birth, it is called congenital spinal stenosis. If the stenosis occurred later in life it is called acquired spinal stenosis.
One of the most common causes of acquired spinal stenosis is changes related to normal, age-related degeneration of your spine, including bone spurs, a disc bulge, and enlargement of a ligament called the ligamentum flavum.
There are two small joints in the back of your spine where one vertebrae meets another vertebrae. These joints, along with the disc, allow you to have motion through your spine. These joints are called facet joints. With normal wear and tear, they can become enlarged and arthritic with bone spurs. This can cause pressure on your nerves.
As we age, we lose height in our discs and they can bulge out into the canal. This can also cause pressure on the nerves. In addition, there is a ligament, the ligamentum flavum, in your spine that connects one vertebrae to another. With loss of disc height and normal wear and tear, this can infold and become enlarged. This can push on nerves leading to severe pain down your legs. This is often called a “radiculopathy.”
Signs and symptoms of spinal stenosis
In addition to pain, pressure on nerves from spinal stenosis can also cause numbness, tingling, burning, and weakness in your legs.
The spinal cord actually ends around the first lumbar vertebra, but nerves that exit the spinal canal below the first lumbar vertebrae continue to travel down the canal and exit at the appropriate level. This bundle of nerves below the end of the spinal cord within the spinal canal is called the “cauda equina” which literally means “horse’s tail.” Severe narrowing of the spinal canal can occur in the setting of spinal stenosis. This can be associated with a rare but emergent condition called “cauda equina syndrome.” Symptoms of this include:
- Difficulty urinating
- Difficulty having a bowel movement
- Numbness and tingling in your inner thighs and groin
An orthopedic physician will suspect spinal stenosis when a patient complains of pain radiating from the back down to the legs. Patients will also commonly complain of numbness, tingling and burning down their legs. They may also have muscle weakness. After a detailed examination, the diagnosis can be initially evaluated with plain X-rays and confirmed with an MRI or CT of the lumbar spine.
Most patients with spinal stenosis can initially be treated conservatively with pain management, physical therapy, and activity modification. Patients with more severe or persistent symptoms may benefit from an epidural spinal injection. Patients with very severe symptoms who do not achieve long-lasting relief from injections may be candidates for surgery.
Most cases of spinal stenosis that require surgery can be treated with a minimally invasive decompression. The goal of surgery is to decompress the nerves. Patients can often go home the same day as surgery. Your surgeon can go over the advantages and disadvantages of the various treatment options with you.
The physicians at Orthopedics International can address your spinal stenosis using the most leading-edge, minimally invasive techniques.