Spinal Stenosis

Spinal stenosis occurs when one or more of the bony openings in the spine (foramina) begin to narrow which reduces the space for the nerves. This process can occur in the spinal canal, where the spinal cord runs through or the intervertebral foramina, where the spinal nerves exit the spine.

Depending on the location and severity of the stenosis, a person with spinal stenosis can experience pain, tingling, numbness or weakness. The most common area for spinal stenosis is in the neck or low back.

Spinal stenosis is most common in people who are over 50 years old. Symptoms will vary depending on the location of the stenosis (narrowing) and which nerves are affected.

In the neck (cervical spine):

• Pain in the neck.

• Tingling or numbness in the arm, hand, foot or leg.

• Weakness in the arm, hand, foot or leg.

• Difficulty with walking & balance.

• In severe cases, loss of bladder, bowel or sexual function. If you are experiencing these symptoms, you should seek urgent medical care.

In the back (lumbar spine):

• Pain in the back.

• Tingling or numbness in the foot or leg.

• Weakness in the foot or leg.

• Pain in one or both legs when standing or walking for prolonged periods. The symptoms will reduce by sitting or bending forwards.

• In severe cases, loss of bladder, bowel or sexual function. If you are experiencing these symptoms you should seek urgent medical care.

Spinal stenosis is generally caused by the normal wear-and-tear process of ageing. Narrowing of the spinal canal or exit foramina is caused by bony spurs (osteophyes), bulging or narrowing discs and thickening and/or reduced elasticity of the spinal ligaments (primarily ligamentum flavum).

Less commonly, the symptoms of spinal stenosis may be experienced due to an injury causing a spinal fracture; or damage to the tissues in the spinal canal resulting in swelling that narrows the space in the spinal cord. Abnormal growths such as tumours will also narrow the space in the spinal canal resulting in the symptoms of stenosis.

Spinal stenosis will be diagnosed based upon symptoms in the majority of cases. Your Physiotherapist will take to full history of your symptoms and perform a comprehensive clinical examination to support an accurate diagnosis and help direct your treatment and management.

Your Physiotherapist will endeavour to get an understanding of how your symptoms are impacting your life. They will work with you to develop a set of personalised goals to assist in your decision making and helping to guide your treatment.

If you are getting significant weakness, loss of balance and loss of bladder, bowel or sexual function you should have an MRI to assess the extent of stenosis and whether surgery may be required. It is not necessary to use MRI in all cases. Multiple studies have shown that people who are asymptomatic (have no symptoms) have signs of stenosis on MRI, therefore this is not a gold standard assessment but simply a part of the assessment. X-rays are used to show bony changes such as osteophytes (bony spurs) that are narrowing the space in the spinal canal.

In most cases the symptoms of spinal stenosis will be managed well using conservative methods. Your Physio can make recommendations on painkillers and non-steroidal anti-inflammatories (NSAIDs) which can be helpful in managing the pain and inflammation around the nerve root. In more severe cases where you may be struggling with neuropathic pain – particularly at night, your GP may prescribe medication such as amitriptyline or gabapentin to help manage this. Your Physiotherapist will educate you on your condition and provide you with useful strategies to help manage your symptoms such as activity modification and pacing your tasks throughout the day.

Your Physiotherapist will also help you manage your symptoms through exercises to relieve your symptoms. They will design a personalised exercise plan for you to build muscle strength & endurance & improve your balance. Regular re-assessment will allow suitable adaptations to be made to your exercise programme and will ensure you are making suitable progress towards your goals.

Your Physio may employ the use of certain techniques such as manual therapy or acupuncture to help you manage pain relating to the condition.

An injection of corticosteroid at the site of the irritated nerve root may be considered when other options have not been successful. The aim of this is to reduce the inflammation around the nerve root and thus reduce pain. Steroid can weaken the connective tissue around the site and so cannot be completed repeatedly.

If other options have been unsuccessful, or if you have significant weakness or loss of bladder or bowel control, then it may be recommended that you have decompressive surgery (laminectomy). This procedure removes a small portion of the vertebrae (the lamina) to increase the space in the spinal canal and exit foramina. Surgery is unlikely to make significant difference to back pain but will aim to reduce leg symptoms particularly muscle strength.