What are the causes of Spinal Stenosis?
Spinal stenosis typically develops as a person ages and the disks become drier and start to shrink. Disc disease such as herniation can also cause stenosis. The bones and ligaments of the spine can also swell or grow larger due to arthritis or chronic inflammation, as in the case of facet arthropathy.
Other problems, including bone disease such as Paget’s disease, tumors, infection and birth defects, can sometimes cause spinal stenosis.
Symptoms of Spinal Stenosis
Most often, symptoms will be on one side of the body or the other. Symptoms often worsen over time gradually.
Common symptoms of stenosis include numbness, weakness, cramping, pain in the back, buttocks, thighs, or calves; or in the neck, shoulders, or arms depending on location of the stenosis.
Symptoms are more likely to be present or get worse when you stand or walk upright. They will often lessen or disappear when you sit down or lean forward. Most people with spinal stenosis cannot walk for a long period of time. Patients with spinal stenosis may be able to ride a bicycle with little pain.
More serious symptoms include difficulty or imbalance when walking, and problems controlling urine or bowel movements.
The diagnostic process includes:
Medical history. The doctor will ask you questions about your symptoms, their severity, and what treatments you have already tried.
Physical examination. You will be carefully examined for limitations of movement, problems with balance and ambulation, range of motion, and pain. During this exam, the doctor will also look for loss of reflexes, muscle weakness, loss of sensation or other signs of neurological injury.
Diagnostic tests. Most doctors start with x-rays, which allow us to rule out other problems such as tumors and infections. The films also allow us to see if there is any loss of disc space between the vertebrae. In most cases, a Magnetic Resonance Imaging or MRI will be ordered to further evaluate the spine and surrounding structures particularly in diagnosing nerve root compression. In some cases, a test called a discography may be done to confirm the diagnosis. This test involves injecting contrast dye into the affected disc (or discs) to create a clearer image.
Diagnostic tests may be needed to further evaluate the cause and source of symptoms. Tests may include nerve conduction studies and electromyography which will test the nerves and muscles affected; X-ray, Spinal MRI, or spinal CT scan to evaluate the spine and surrounding structures.
Generally, conservative management is encouraged. This involves the use of medications, physical therapy, and lifestyle changes. Steroid injections may relieve pain for a period of time. When your back pain does not go away completely, or it gets more painful at times, learning to take care of your back at home and prevent repeat episodes of your back pain can help you avoid surgery.