Spinal stenosis

George Rappard, MD

Spinal stenosis is a unique cause of back pain caused by narrowing of the spinal canal. The spinal canal is a tube surrounded by bone that extends from the top to the bottom of the spine. Within the spinal canal travels the spinal cord, nerves and blood vessels. Narrowing of the spinal canal, or spinal stenosis, is usually caused by degeneration of the spine. This degeneration is the result of bulging of the disc joints, bony growth of the facet joints or overgrowth of the ligaments of the spine. Sometimes, anatomic factors, like being born with a narrower than normal spinal canal, will predispose people to developing symptoms of spinal stenosis.. Spinal stenosis results in a pain syndrome referred to as pseudoclaudication. In pseudoclaudication, patients experience pain while walking. This pain is across the back and radiates to the thighs and buttocks. Pain may radiate to the ankle and foot. The pain usually improves after sometime with sitting or leaning forward. Leaning back may make the pain worse. The pain in pseudoclaudication is from compression of groups of nerves and/or compression of veins in the spinal canal. When there is compression of the spinal veins this can cause swelling and congestion of the nerve roots, leading to irritation. This is usually the case when there is central stenosis, or narrowing of the central part of the spine. When spinal stenosis affects an individual nerve, symptoms may be due to nerve root compression. This is the case when there is foraminal and lateral recess stenosis. This involves narrowing of the individual nerve outlet. If treatment with rest, medications and pain management injections fails, then a procedure may be required for treatment of back pain due to spinal stenosis. Traditionally, this involves removal of of bone and ligaments to decompress the spine. Recent advances allow the use of minimally invasive therapies for the treatment of symptomatic spinal stenosis.

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