Overview
Spinal stenosis is a condition characterized by the narrowing of the spinal canal or neural foramina, leading to compression of the spinal cord or spinal nerves. It most commonly affects the lumbar spine (lower back) and cervical spine (neck), and is a leading cause of pain and disability in older adults.
The condition can be congenital (present at birth) but is more often acquired due to degenerative changes associated with aging.
Common Causes
Degenerative disc disease – Loss of disc height and bulging can reduce space for nerves.
Facet joint arthropathy – Arthritic changes in the joints of the spine lead to bony overgrowth (osteophytes).
Ligamentum flavum hypertrophy – Thickening of spinal ligaments further narrows the canal.
Herniated discs – Disc protrusions can compress nerve roots.
Spondylolisthesis – Vertebral slippage that narrows spinal passages.
Post-surgical changes – Scar tissue or instability after spinal procedures.
Symptoms
Lumbar stenosis:
Lower back pain with radiating leg pain (neurogenic claudication)
Pain relief with sitting or leaning forward (e.g., shopping cart sign)
Numbness, tingling, or weakness in legs
Difficulty walking long distances
Cervical stenosis:
Neck pain with radiating arm pain
Hand clumsiness, balance issues
In severe cases, signs of myelopathy (spinal cord compression)
Treatment Options
Conservative Treatments
Physical therapy – Core strengthening, posture correction, and mobility training
NSAIDs or oral steroids – To reduce inflammation and discomfort
Lifestyle modifications – Weight loss, activity pacing, and ergonomic corrections
Bracing – Occasionally used for support in unstable segments
Interventional Pain Management Options
When conservative care is insufficient, interventional procedures may offer effective relief:
Epidural Steroid Injections (ESI)
Deliver corticosteroids into the epidural space to reduce nerve inflammation and relieve radicular symptoms.
Transforaminal ESI
A targeted approach ideal for foraminal stenosis affecting specific nerve roots.
MILD Procedure
Minimally invasive techinique to remove excessive ligamentum flavum causing pressure on the spinal cord
Interspinous Process Spacers (e.g., Minutema)
Minimally invasive implants that restore space in the spinal canal and offload pressure from nerves, preserving motion without fusion.
Medial Branch Blocks and Radiofrequency Ablation (RFA)
Used when facet joint degeneration is a primary pain generator.
Spinal Cord Stimulation (SCS)
Considered for chronic pain not responsive to injections or surgery, especially in cases of failed back surgery syndrome.
Surgical Options
Laminectomy – Removal of part of the vertebra (lamina) to decompress nerves.
Foraminotomy – Widening of the neural foramina where nerves exit.
Spinal fusion – Stabilization for patients with instability or multi-level disease.
Minimally invasive decompression – Newer techniques allow faster recovery with less tissue disruption.
Conclusion
Spinal stenosis is a common, often progressive condition that can significantly limit mobility and function. Fortunately, a range of non-surgical and interventional treatments can effectively manage symptoms and improve quality of life. Early recognition and a personalized treatment approach are key to optimal outcomes.