Understanding the Basics of Spinal Stenosis, Exploring Pain Management and Treatment Strategies from a Pain Management Specialist

Spinal stenosis is a common challenge impacting millions worldwide. Yet, amid the hustle of our daily lives, spinal stenosis tends to slip under the radar despite its significant impact.

Get ready to cut through the complexity as we guide you through the ins and outs of spinal stenosis, unraveling its causes, symptoms, and practical solutions. No jargon – just straightforward insights and strategies to help you face spinal stenosis head-on.

Join us in exploring this widespread issue, spotlighting the facts you need to know.

What is spinal stenosis?

Spinal stenosis is the narrowing of spaces within your spinal canal, the tunnel running through each vertebra in your spine that houses the spinal cord.^[1] When this space tightens, it puts pressure on your spinal cord and the nerve roots branching off it, potentially causing irritation, compression, or pinching.

The consequences? Back pain and nerve issues, like sciatica. Various conditions and injuries can lead to this narrowing of the spinal canal, affecting anyone but becoming more common as we age, especially for those over 50.^[2]

Spinal stenosis commonly impacts two areas of the spine:

1. Lower Back (lumbar spinal stenosis)
   1. Your lumbar spine, comprising the five largest vertebrae (L1 to L5), takes the hit. This section bears the brunt of the narrowing, often causing discomfort.^[3]
2. Neck (cervical spinal stenosis)
   1. Moving upward to the cervical spine – seven vertebrae (C1 to C7) in your neck.^[4]

Spinal stenosis in the middle back (thoracic spine) is rare but can also happen.

Causes and Risk Factors of Spinal Stenosis

The bones in your spine act like a protective column, running from the skull to the tailbone. Within this column lies the spinal cord, safely housed in the spinal canal.

While some people are born with a naturally smaller spinal canal, most cases of spinal stenosis stem from events that reduce the open space within the spine.

Common causes of spinal stenosis include: ^[5]

• Bone Spurs: Arthritis can lead to the growth of extra bone on the spine – known as bone spurs. These protrusions can take up residence in the spinal canal, causing trouble. Keep an eye out for Paget’s disease, too, as it’s another culprit for this bone growth.
• Herniated Disks: Your disks act as soft cushions between spinal bones. If part of the inner material comes out, it can press on the spinal cord or nerves, causing pain.
• Thick Ligaments: The strong cords keeping your spine’s bones in place can become stiff and thick over time. This thickness can cause unwanted pressure on the spinal canal.
• Tumors: While rare, tumors forming inside the spinal canal can contribute to the narrowing.
• Spinal Injuries: Car accidents or other traumas can be culprits, causing spinal bones to break or shift. Even the aftermath of back surgery, with its post-op swelling, can apply pressure to the spinal cord or nerves.

Now, let’s look at who might be more at risk of facing spinal stenosis. Risk factors for spinal stenosis can include:

• Age: Spinal stenosis becomes more common as we age, especially for those over 50.
• Genetics: Some people are born with a naturally smaller spinal canal, increasing their susceptibility.
• Trauma: Accidents and injuries, particularly those affecting the spine, can elevate the risk of developing spinal stenosis.

Symptoms of Spinal Stenosis

The symptoms of spinal stenosis can be as varied at the locations it chooses to occupy and the intensity it decides to exhibit. Potential symptoms in the neck, back, arms, legs, hands, or feet can include:

• Pain
• Tingling
• Numbness
• Weakness

Spinal stenosis develops gradually, unfolding its impact over time. Consequently, initial symptoms may not be noticeable, even if diagnostic tests like X-rays show its existence. Subsequently, when symptoms do emerge, they can vary from person to person.

Symptoms of Lumbar Spinal Stenosis:

• Low back pain extending down the leg
• Leg heaviness and cramping
• Numbness or pins and needles in the buttocks, leg, or foot
• Positional pain aggravated with prolonged standing, walking, or descending

Symptoms of Cervical Spinal Stenosis:

• Neck pain
• Numbness or pins and needles in the arm, hand, leg, or foot
• Weakness or clumsiness in the arm, hand, leg, or foot
• Balance problems
• Hand functionality issues

Diagnosing Spinal Stenosis

After thoroughly reviewing your medical history and a comprehensive physical exam, imaging tests are used to understand the issue better. ^[6]

• Spine X-ray: Reveals changes in bone structure, such as loss of disk height or the presence of bone spurs.
• MRI: Shows detailed cross-sectional images of your spine, offering insights into nerves, disks, spinal cord, and the detection of tumors.
• CT Scan or CT Myelogram: Combines X-rays to create a cross-sectional image of your spine. Using a contrast dye, a CT myelogram enhances visibility for a clearer view of your spinal cord and nerves.

Managing and Treating Spinal Stenosis

Spinal stenosis can induce acute and chronic pain that stems from nerve compression, resulting in numbness in the legs, arms, and shoulders. Similar to arthritis, spinal stenosis is a gradual process. Without adequate treatment, the condition may progress, leading to a continued narrowing of the spinal column and a worsening of spinal stenosis symptoms over time.

Pain Relief Treatment for Spinal Stenosis

For those struggling with mild spinal stenosis, a range of non-surgical treatments can effectively alleviate symptoms and foster an active lifestyle, including: ^{[7] [8]}

Over the Counter Medications

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, and naproxen, offer accessible relief by reducing inflammation in nerve roots and spine joints, creating more space within the spinal canal. These medications are often a first-line approach, providing a manageable option for individuals with mild spinal stenosis.

Physical Therapy

Physical therapy tailored for spinal stenosis focuses on posture modification and strengthening core muscles, particularly in the abdomen and thighs. This targeted approach can open the spinal canal, alleviating nerve compression.

Manual Spine Manipulation

Manual spine manipulation, performed by healthcare professionals, involves hands-on adjustments to realign the spine. This approach aims to alleviate nerve pressure and optimize spinal function.

Epidural Injections

Epidural injections deliver corticosteroids directly to the affected area, reducing pain and inflammation associated with spinal stenosis. This targeted approach can provide significant relief for individuals experiencing moderate to severe symptoms.

Narcotic Pain Medications

In some cases, when over-the-counter medications prove insufficient, you may be prescribed stronger narcotic pain medications for short-term relief. These medications, while effective in managing pain, are typically used cautiously due to potential side effects and the risk of dependency. They may be considered when other non-surgical options have been explored and deemed appropriate for your condition.

Surgical Interventions for Spinal Stenosis

Individuals grappling with severe cases of spinal stenosis may find that surgical intervention becomes a necessary consideration. In these instances, surgical procedures are designed to address the root cause by creating additional space within the spinal canal. This surgical approach aims to alleviate the heightened pressure on the spinal cord and nerves, ultimately reducing pain and significantly improving the various symptoms associated with spinal stenosis.

Your Path to a Pain-Free Future Begins with Sonoran Pain and Spine

In spinal stenosis, understanding its nuances and seeking tailored solutions is pivotal to reclaiming a life free from persistent pain. Whether exploring non-surgical avenues like physical therapy, over-the-counter medications or considering more advanced options such as epidural injections or surgical interventions, your path to relief is unique.

At Sonoran Pain and Spine, we specialize in uncovering the root causes of your back pain and crafting personalized, non-surgical pain management plans. Our expertise, including techniques like epidural injections, is dedicated to addressing your specific needs, empowering you to rediscover the joy of everyday life without the burden of constant discomfort.

Take the first step toward a pain-free future – don’t wait. Schedule an appointment with us today and embark on a journey to reclaiming a life full of vitality and well-being. Your path to relief starts now.

Resources

1. “Lumbar Spinal Stenosis | Physical Medicine and Rehabilitation | JAMA.” 3 May. 2022, https://jamanetwork.com/journals/jama/fullarticle/2792079. Accessed 15 Nov. 2023.
2. “Review of Lumbar Spinal Stenosis with Intermittent Neurogenic ….” https://academic.oup.com/painmedicine/article/20/Supplement_2/S32/5661169. Accessed 15 Nov. 2023.
3. “Lumbar Spinal Stenosis – ScienceDirect.com.” https://www.sciencedirect.com/science/article/abs/pii/S1521694209001247. Accessed 15 Nov. 2023.
4. “Degenerative Cervical Spinal Stenosis – PMC – NCBI.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696878/. Accessed 15 Nov. 2023.
5. “Lumbar Spinal Stenosis | Johns Hopkins Medicine.” https://www.hopkinsmedicine.org/health/conditions-and-diseases/lumbar-spinal-stenosis. Accessed 15 Nov. 2023.
6. “Lumbar Spinal Stenosis: Pathophysiology and Treatment Principle.” 14 Oct. 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7595829/. Accessed 15 Nov. 2023.
7. “Lumbar spinal stenosis: an update on the epidemiology, diagnosis ….” 26 May. 2017, https://amj.amegroups.org/article/view/3837/4553. Accessed 15 Nov. 2023.
8. “Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To ….” https://www.sciencedirect.com/science/article/pii/S1526590021001887. Accessed 15 Nov. 2023.