The spine, also called the backbone or spinal column, is made up of 33 bones (vertebrae) from the bottom of the skull to the buttocks. Ligaments connect these bones. Between most vertebrae are flattened, round structures (intervertebral disks) composed of a soft substance in the middle and stronger outer covering. The spinal cord, which holds the nerves, runs through and is protected by vertebrae. Muscles in the back and abdomen support the spine.
Spinal stenosis is a narrowing in a part of the spine.
The cause is usually wear and tear, past injury, disk rupture (herniation), or osteoarthritis related to aging. As disks between vertebrae wear out, spaces between vertebrae narrow. Vertebrae become deformed and may develop spurs (bony outgrowths or bulges) that can compress spinal nerves.
Symptoms depend on which area of the spine is narrowed. Narrowing of the lower part produces pain in the lower back, buttocks, and thighs. In severe cases, legs or arms may become numb and weak.
Pinching (compression) of a spinal nerve root may cause intense pain in the buttocks or down the leg. Sciatica means pain in the leg caused by pinching, swelling (inflammation), or injury of the sciatic nerve. This nerve runs from the lower spine, down the buttock and back of the knee to the foot. Numbness and pins and needles may also be felt.
Spinal stenosis pain is worse during walking (especially downhill) or standing and gets better by bending forward.
A medical history and physical examination are used for diagnosis. The health care provider may order blood and urine tests to see whether another disorder may be causing symptoms. X-rays of the spine will be done. Magnetic resonance imaging (MRI) of the spine may be done if a better picture is needed of bones, nerves, disks between vertebrae, and other tissues, or if surgery is being considered. A nerve conduction test may tell whether pressure on nerves is causing numbness or tingling in the legs.
Physical therapy may help reduce pain and improve mobility.
Over-the-counter pain relievers, such as acetaminophen, or nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen, can help. For really severe pain, stronger narcotic medicines may be used for a short time. All drugs have side effects. NSAIDs may cause stomach upset, rash, and internal bleeding. Narcotic drugs may also cause drowsiness and constipation and can be habit forming.
Surgery is used only for pain that doesn’t go away. The operation may remove the disk (diskectomy) to relieve pressure on a nerve, or remove part of the bony arch, or lamina, of a vertebra (laminectomy) for a herniated disk. Removal of the vertebral body and surrounding soft tissue is called decompressive laminectomy. In people with spinal stenosis and instability of the spine, bone graft to maintain the structural support of the spinal column (spinal fusion) may be done following decompressive laminectomy.
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