Spinal stenosis is another painful chronic condition that results from gradual spinal cord compression by severe narrowing of the spinal canal. The narrowing can be congenital but is usually acquired through increasing degenerative/bulging discs, increasingly enlarged arthritic facet joints, and thickened ligaments that surround the spinal canal.
The most common symptom of lumbar spinal stenosis is pain often described as deep, aching or cramping in the back, buttocks, thighs and legs. The pain is classically exacerbated by exercise. Pain is relieved by stopping the activity, forward flexing the back by sitting or bending over (which increases the space around the nerve roots and decreases tension on the nerve roots, thus relieving the painful compression of the nerve fibers).
What are the causes?
- aging process (degeneration of discs and enlargement of arthritic facet joints)
- occasionally, congenital malformation of the vertebrae
What treatment options are available?
Treatments vary from conservative, for those with manageable pain, to rather extensive surgery for those whose pain is so severe that they are unable to walk more than a few steps. Conservative treatment consists of exercise, especially where flexion can be maintained, such as bicycling. Swimming is also a comfortable activity for those with stenosis.
Epidural injections of steroids and local anesthesia are temporarily beneficial to many patients, particularly those who are older and exhibit more leg than back pain. Surgery to reduce the stenosis is reserved for severe cases; it may increase the ability of the person to walk by relieving the leg pain, but the back pain often persists. An unfortunate frequent side effect of the surgery is a frequent destabilization of the spine, sometimes necessitating fusion surgery later. Spinal cord/ dorsal column stimulation is a frequently useful option and requires a relatively minor operative procedure.