Spinal stenosis is a narrowing of the spinal canal in the upper (cervical) or lower (lumbar) part of the spine. The narrowing applies pressure on the spinal cord and/or nerves. While some people are born with this condition, the majority of occurrences of stenosis are the consequence of aging and “wear and tear” on the spine in patients typically over the age of 50.
Cervical Stenosis
In this condition, the narrowing occurs in the part of the spine in your neck.
Lumbar Stenosis
In this condition, the narrowing occurs in the part of the spine in your lower back. It’s the most common form of spinal stenosis.
Symptoms
The symptoms of cervical and/or lumbar spinal stenosis can include:
- Neck pain; occasionally severe
- Pain, weakness, or numbness in the shoulders, arms, and legs
- Hand clumsiness
- Walking and balance disturbances
- Burning sensations, tingling, and pins and needles in the involved extremity, such as the arm or leg
- Low back pain that eases when bending forward or sitting
- Pain, weakness, or numbness in the legs, calves, or buttocks
- Bladder and bowel problems (in severe cases)
- Although rare, very severe cases can also cause significant loss of function or even paraplegia
Treatments
Non-Surgical
Cervical
Most cases of cervical stenosis are successfully treated with non-surgical techniques such as pain and anti-inflammatory medications. Depending on the extent of nerve involvement, some patients may need to temporarily restrict their activities and wear a cervical collar or neck brace for a time. However, most patients only need to rest for a brief time. Physical therapy exercises will also be prescribed to help strengthen and stabilize the neck, as well as build endurance and increase flexibility. Failing the aforementioned treatment options, a cervical epidural steroid injection can be considered to potentially reduce inflammation around the spinal cord and the associated nerves.
Lumbar
Similar to cervical spinal stenosis, lumbar spinal stenosis is treated in similar fashion with medications, activity modification, therapy, bracing, and/or epidural steroid injections.
Surgical Treatment
Cervical
One method of treating cervical stenosis is called a decompressive laminectomy, in which the laminae (roof) of the vertebrae are removed, creating more space in the spinal canal for the nerves. If only a portion of the laminae needs to be removed, it is called a laminotomy.
Your surgeon may also consider performing a posterior laminoplasty. This technique helps to retain spinal stability while also expanding the spinal canal.
Herniated or bulging discs may also be removed (a procedure known as a discectomy) to increase canal space. Sometimes, the foramen (the area where the nerve roots exit the spinal canal) also needs to be enlarged. This procedure is called a foraminotomy.
Spinal fusion may be performed in addition to decompression surgery for patients who require surgical repair at many levels or who have considerable spinal instability. This involves taking a small piece of bone and grafting it onto the spine. Spinal hardware (called Anterior Cervical Discectomy Fusion (ACDF)), such as plates and screws, supports the spine and provides additional stability. In most cases, we can determine ahead of time if fusion surgery is necessary. If it is, we will discuss this with you so that you are aware of what is being done. Spinal fusion can also be achieved from a posterior approach called posterior cervical decompression and fusion (PCDF) during which the posterior portion of spine is stabilized with screws/rods and the space for the neural anatomy is opened by performing a laminectomy.
ACDF (Anterior Cervical Discectomy and Fusion)
Cervical ADR (Artificial Disc Replacement)
Lumbar
The most common surgery for lumbar stenosis is called a decompressive laminectomy, in which the laminae (roof) of the vertebrae are removed, creating more space in the spinal canal for the nerves. If only a portion of the laminae needs to be removed, it is called a laminotomy. If there are herniated or bulging discs, these may also be removed (this is called a discectomy) to increase canal space. Sometimes, the foramen (the area where the nerve roots exit the spinal canal) may also need to be enlarged. This procedure is called a foraminotomy.
For those patients who need surgical repairs on more than one level or who have significant spinal instability, spinal fusion may be required in addition to decompression surgery. This traditionally involves taking bone from the patient and/or bone graft substitutes made by various manufacturers and grafting it onto the spine. For some cases, we have used bone substitutes such as bone morphogenetic proteins (BMPs) to facilitate spine fusion. Spinal implants such as screws and rods are used to support the spine and provide additional stability while the fusion is healing. In most cases, we can identify beforehand if fusion surgery is necessary. At our practice, we perform many fusions using minimally invasive surgical techniques, thus reducing trauma to soft tissues, reducing blood loss, and ultimately leading to a more rapid recovery. We will discuss this with you in advance if a fusion is necessary.
