The human spine houses the spinal cord, the second half of the central nervous system after the brain, and is a critical conductor for signals between the brain and the rest of our body. Unlike many other nerves, the spinal cord cannot regenerate after being severed, so the spine plays a dual role in allowing us to stay upright and move the way we do, protecting one of the essential nerve highways in the body. Spinal stenosis pain is a leading factor in spinal issues for many people.
Spinal stenosis is a more common and dangerous condition affecting the spine. As such, spinal problems are always a cause for concern, even during a minor. Spine specialists utilize physical exams and imaging tests to identify and eliminate potential causes for back pain and other indications of a spinal condition.
What Is Spinal Stenosis?
Spinal stenosis is a condition characterized by a narrowing spinal canal. The spinal canal is a long and narrow passage running through the entirety of the spine through each vertebra. A closer look at the anatomy of our vertebrae reveals some of how the spinal canal might narrow. Each vertebra is a hard bony disc, with spinous protrusions and facets, like the jagged fins of a fish.
The spinal canal runs between the vertebral body (the round disc) and these protrusions. Individual nerve roots branch out of openings between said protrusions, creating the peripheral nervous system that makes up all our sensory, motor, and autonomous nerves. These small openings and the canal can be blocked or compressed by bone spurs or other abnormal bony growths, tumors, swelling, inflammation, or injury.
The resulting pressure can compress and cut off certain nerve roots from the spinal cord and cause muscle weakness, tingling sensations, loss of strength, numbness, and chronic pain. Severe spinal stenosis cases can lead to bowel control loss and even paralysis. Not all forms of spinal stenosis are this serious, however. Spinal stenosis occurs in all three significant portions of the spine, the cervical (neck), thoracic (upper back), and lumbar (lower back). However, the neck and lower back are disproportionately affected.
In some cases, an injury or inflammatory reaction might cause temporary unilateral pain or sciatica before going away. In other cases, conservative treatment from a specialist – including anti-inflammatories, over-the-counter pain medication, and a round of physical therapy – can reduce and even eliminate symptoms, avoid progressive illness, and help prevent future episodes. Nevertheless, it is good to approach your doctor if you have any signs of spinal stenosis or other conditions.
Signs and Symptoms of Spinal Stenosis
As a spinal condition, a common telltale sign of spinal stenosis is back or neck pain. Identifying these conditions on pain alone is challenging because spinal stenosis can occur along any part of the spine and shares some of its symptoms with several other states. Furthermore, some report the pain as dull or throbbing, while others report intermittent, sharp bursts. Other symptoms can help narrow things down, including:
- Problems with balance.
- Pain that gets worse by standing for long periods or going downhill.
- Pain that gets better by leaning forward, walking uphill, or sitting down.
- Clumsiness in the hands, difficulty performing fine motor skills despite having no difficulty before.
- One-sided pain radiates down your entire right arm or flows down your left leg.
- A heavy feeling in your limbs, frequent cramping, numbness, and significant loss of strength in one side.
- Frequent pins and needles in the feet, legs, or butt, even if you haven’t cut off circulation by sitting on your leg, etc.
How Is It Diagnosed?
In addition to identifying these symptoms, your doctor may also perform a physical exam to determine the chance of a case of spinal stenosis. Most doctors will complete this exam by testing for tender or painful spots along the neck and back and asking you to bend in specific ways to see if the pain worsens. Other parts of a physical exam may include:
- Balance tests.
- Strength tests.
- Observing a patient’s gait.
- Testing for numbness or sensitivity in the palms and feet.
If your canal narrows by swelling on the right side, for example, leaning to the left may help provide more space for the nerve roots and the portion of the cord being compressed, alleviating your pain. Imaging tests help identify different cases of spinal stenosis. Other clinics may utilize spine care tests or various forms of imaging – such as CT scans, MRIs, or conventional x-rays. When using an x-ray, your doctor may inject a contrast dye into the part of the back or neck that hurts the most to identify any swelling or abnormalities better.
In some cases, diagnostic nerve blocks may help identify the cause of your pain, especially if there are other potential causes or influencing factors. A nerve block is a temporary anesthetic injection cutting off pain signals from the target nerve to the body. In the case of spinal stenosis, nerve blocks help determine whether the area in question is what’s causing you pain. Diagnostic nerve blocks usually only last a few hours, at best.
Spinal Stenosis Pain Management and Treatment
The first-line treatment for spinal stenosis depends on the severity of the condition. For the majority of cases, a conservative approach is best. Medication helps reduce potential swelling, while over-the-counter pain killers manage various pain types. Patients with certain risk factors for persistent or recurring pain must reduce their body weight. If this doesn’t work, you will need to start exercising with an experienced personal trainer.
This training will help address weakened muscles and reduce the likelihood of future spinal conditions. Physical therapy is also key to addressing the short-term pain symptoms of spinal stenosis. More chronic severe pain may require a long-term pain management treatment plan. In addition to over-the-counter medication and physical therapy, a patient may need corticosteroid injections to reduce inflammation, pain, and other non-surgical interventions.
If the cause of the pain is a bone spur or spinal tumor, surgery is the best action to remove the excess tissue or create more space for the spinal cord and surrounding nerve roots. In other cases, specialized surgical implants may help decompress the nerves by creating more space between the vertebrae through a titanium support structure. If you are experiencing any symptoms of spinal stenosis, it’s better to be safe than sorry. Spinal stenosis can vary from minor to severe. It often goes away independently with rest, movement, and a few ice packs. In other cases, a specialist’s approach will help with unforeseen issues.