Degenerative stenosis is a common spinal condition involving a narrowing of spaces within the spinal column. This narrowing can put pressure on the spinal cord and nerves, leading to various symptoms that affect mobility and comfort. While it is a progressive condition, various approaches exist to manage its effects.
What Degenerative Stenosis Is
Degenerative stenosis refers to the narrowing of the spinal canal or nerve root openings, often due to age-related changes. The “degenerative” aspect means it develops from the natural breakdown of spinal components over time. This process commonly begins with intervertebral discs, which act as shock absorbers, losing water and shrinking, typically by age 50.
As discs degenerate, they can settle or collapse, placing increased stress on the facet joints. This can lead to osteoarthritis, causing the facet joints to enlarge and thicken. The body may also grow extra bone, forming bone spurs (osteophytes) that protrude into the spinal canal. Ligaments can also become stiff and thicken, further reducing space. This narrowing can compress the spinal cord and/or nerve roots, leading to irritation or pinching.
Degenerative stenosis most frequently occurs in the lumbar spine (lower back) and the cervical spine (neck). In the lumbar spine, narrowing can affect the central canal or lateral recesses. In the cervical spine, narrowing can occur in the central canal where the spinal cord passes, or in the neural foramina. The thoracic spine (middle back) can also be affected, though less commonly.
Common Symptoms
The symptoms of degenerative stenosis arise from spinal cord or nerve root compression. Individuals may experience pain, numbness, tingling, or weakness. These symptoms often develop gradually and can worsen with certain activities.
For lumbar spinal stenosis, symptoms affect the lower back and legs. Patients often report pain or cramping in one or both legs, extending into the buttocks or feet, known as sciatica. This leg pain commonly intensifies with prolonged standing or walking, especially downhill, and often finds relief when bending forward or sitting. Some individuals may also describe a heavy feeling in their legs or experience numbness and a “pins and needles” sensation in the buttocks, legs, or feet.
Cervical spinal stenosis symptoms are felt in the neck, arms, and hands, sometimes extending to the legs and feet. Neck pain is a common symptom, which can radiate into the shoulders or arms. Numbness, tingling, or a “pins and needles” sensation in the arms, hands, and fingers are common due to nerve compression. As the condition progresses, muscle weakness or clumsiness can develop in the arms, hands, or even the legs, making activities that require fine motor skills, such as buttoning a shirt or writing, more challenging. Balance problems can also occur if the spinal cord is compressed.
How Degenerative Stenosis Is Diagnosed
Diagnosing degenerative stenosis involves a thorough medical history and physical examination. The medical history helps understand symptom onset, what activities worsen or ease them, and the presence of numbness, tingling, or weakness. The physical examination assesses sensory abnormalities, reflexes, and muscle weakness to pinpoint the location of nerve compression.
Imaging tests confirm the diagnosis and determine the narrowing’s extent and location. X-rays are often a first step, revealing bone changes like reduced disc height, fractures, or bone spurs, but provide limited soft tissue detail. Magnetic Resonance Imaging (MRI) provides detailed images of soft tissues, including nerves, discs, and ligaments, clearly showing spinal nerve compression and disc or ligament damage.
A Computed Tomography (CT) scan is another imaging option, especially if MRI is not possible due to implants. A CT scan combines X-ray images from various angles for detailed cross-sectional views. Sometimes, a CT myelogram is performed, involving injection of contrast dye into the fluid around the spinal cord and nerves for a clearer view of narrowing or compression. These imaging tests confirm clinical findings and rule out other conditions.
Treatment Options
Treatment for degenerative stenosis typically begins with conservative, non-surgical approaches aimed at managing symptoms and improving function. Oral medications are often prescribed, including nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain. For chronic pain, prescription medications such as gabapentin or amitriptyline may be used to help ease nerve-related discomfort.
Physical therapy is a common initial treatment, where a therapist teaches exercises to build strength, endurance, improve balance, and maintain spinal flexibility and stability. This includes stretches for the lower back and limbs, and strengthening exercises for core and trunk muscles. Epidural steroid injections, another non-surgical option, involve injecting corticosteroids into the epidural space around spinal nerves. These injections provide short to medium-term pain relief (often 3-36 months) by reducing inflammation, and are frequently used with rehabilitation.
Surgical intervention is considered when conservative treatments fail, or symptoms are severe, progressive, or involve significant weakness or loss of bowel or bladder control. Decompression surgery aims to relieve pressure on the spinal cord or nerves. Common surgical procedures include:
- Laminectomy: This involves removing part or all of the lamina (a vertebral bone section), thickened ligaments, and bone spurs to create more space.
- Laminotomy: This involves removing a smaller portion of the lamina to preserve natural spinal support.
- Foraminotomy: This procedure widens the neural foramen (nerve root exit openings) by removing bone or tissue.
- Spinal Fusion: This permanently joins two or more vertebrae using bone graft, often with screws and rods, to stabilize the spine. It may be performed with decompression if instability is a concern.
Treatment plans are individualized, considering the severity of symptoms and the specific characteristics of the stenosis.