FAQs of Spinal Stenosis and Treatment Options

Spinal stenosis is a condition that occurs due to narrowing of the spaces within the spinal column. This narrowing leads to pressure on the spinal cord and nerves, which is often the result of wear and tear to the spine. Aging is a contributor to spinal stenosis, as it mainly affects individuals who are over the age of 50 years.

What are the symptoms of spinal stenosis?

The symptoms of spinal stenosis depend on the site of the narrowing. A patient with cervical spinal stenosis often has numbness, weakness, and tingling of the hand, arm, and/or shoulder. With lumbar spinal stenosis, there are many compressed lumbar spine nerves, which cause weakness, pain, and cramping of the buttock, leg, and/or foot on the affected side.

How common is spinal stenosis?

According to statistics, the incidence of lumbar spinal stenosis in America is around 10%. Experts predict that by the year 2020, this condition will affect 2.4 million people due to the aging population. Spinal stenosis surgery occurs at a rate of 2 per 1,000 Medicare beneficiaries, which is expected to double as the population ages.

What causes spinal stenosis?

Many conditions and circumstances contribute to the development of spinal stenosis. These include:

  • Overgrowth of bone, which occurs from bone spur formation that impinges nerves
  • Being born with a small spinal canal (congenital)
  • Thickened ligaments that become stiff and bulge into the spinal canal
  • Herniated disc that press on spinal nerves
  • Injuries that cause dislocations or fractures in vertebrae

How is spinal stenosis treated?

The treatment for spinal stenosis depends on the cause, the severity of the pain, and the patient’s health status. Treatment options include:

  • Medications – The cornerstone of pain management involves medications. The options include nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, muscle relaxants, and analgesics. In addition, neurogenic stabilizing medications have been shown to help including Lyrica or Neurontin.
  • Epidural steroid injection (ESI) – The epidural space lies between the spinal cord and the epidural layer. With ESI, the doctor injects a steroid into this space at the location of the nerve inflammation. According to studies, the efficacy rate of ESI is between 80 and 90%.
  • Facet joint denervation – To destroy nerves that produce pain associated with spinal stenosis, the doctor inserts a small needle with catheter through the skin and into the facet joint space of the spine. Radiofrequency energy can be transmitted from a tiny instrument, which coagulates the nerves. In a recent clinical study, the success rate of denervation was 76%, and most patients reported at least a 50% reduction in pain, which lasted up to three weeks post-procedure.

Resources

Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, et al. (2009). Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine Journal, 9(7), 545-50.

McLain, RF, Kapural L, & Mekhail NA (2005). Epidural steroid therapy for back and leg pain: mechanism of action and efficacy. Spine Journal, 5, 191-201.

Shamie N (2012). Lumbar spinal stenosis: The growing epidemic. Retrieved from: http://www.aaos.org/news/aaosnow/may11/clinical10.asp

Streitberger, K, Muller, T, Eichenberger, U, et al. (2011). Factors determining the success of radiofrequency denervation in lumbar facet joint pain: a prospective study. European Spine Journal, 20(12), 2160-2165. doi:  10.1007/s00586-011-1891-6