The Narrowing Facts On Spinal Stenosis
By: Dyan Quesada, MPT, ATC

Spinal Stenosis is the narrowing of the spinal canal. Unlike a disk herniation, which is an acute nerve compression, spinal stenosis occurs gradually. Although it can be inherited (e.g. a person can have a small spinal canal), most cases are acquired, are most common in people over the age of 50, and occur in the lumbar region of the spine.

Structural changes and inflammation begins the process of Spinal Stenosis (Figures 1, 2, 3.) Ligaments of the spine may thicken and harden. Bones and joints (joints in the vertebra are called facet joints) may enlarge and become arthritic, and osteophytes (bone spurs) may form. The lumbar disks may degenerate and collapse. All of the above changes contribute to the narrowing of the spinal canal, and result in pressure on the spinal cord and nerve roots.

Some Causes of Spinal Stenosis

Symptoms associated with spinal stenosis include radicular pain, weakness, or cramping usually involving both legs, and almost always worsening with prolonged ambulation. Most commonly a patient will report that the distance he/she can ambulate before leg pain is experienced, decreases as the stenosis progresses. Patients have increased symptoms when extending the back, and decreased symptoms when bending forward. This is the reason why patients may “hunch” forward when walking. In severe cases, abnormal bowel and bladder function can occur.

The definitive diagnosis is provided by imaging studies such as MRI, CT Scan, and Myelogram.

Physicians may prescribe nonsteroidal anti-inflammatory drugs (e.g. Aspirin) to reduce inflammation and relieve pain or analgesics (e.g. Tylenol) to relieve pain. Corticosteriod injections to the outer most membranes of the spinal cord may be used to reduce pain and inflammation in the legs. Physical Therapy is also important to design an exercise program that will maintain motion of the spine and keep a patient functional in their daily activities.

References

Donatelli, Robert, and Wooden, Michael. Orthopaedic Physical Therapy- 3rd Edition. Churchill Livingstone, Philadelphia, 2001.

Richardson Jan, and Iglarsch Z. Annette. Clinical Orthopaedic Physical Therapy. W.B. Saunders Company, Philadelphia, 1994.

National Institute of Arthritis and Musculoskeletal and Skin Diseases (www.niams.nih.gov), “Questions and Answers About Spinal Stenosis,” October 1999.