Spinal Stenosis

What is spinal stenosis?

Spinal stenosis is when the channel that is formed by the bones of your spine to protect your spinal cord and nerve roots narrows, and puts pressure on the nerves that travel through your spine. It is most common in the lower back and the neck. 

Spinal stenosis is classified according to where on the spine the condition occurs. The two main types of spinal stenosis are:

  • Cervical stenosis: where the narrowing is in the part of the spine that’s in your neck.
  • Lumbar stenosis: where the narrowing is in the part of the spine in your lower back. This is the most common form of spinal stenosis.

Who gets spinal stenosis?

A person can be born with spinal stenosis, but usually it happens in older people (over the age of 50) due to wear and tear as you age. 

What is the main cause of spinal stenosis?

Spinal stenosis is a degenerative spinal disease and usually develops over time. The most common cause is damage caused by osteoarthritis which can cause bone spurs to grow into the spinal canal. Other causes include: 

  • Herniated disks. These shock absorbers between your spinal vertebrae tend to dry out with age and can crack, releasing some of the soft inner material, which then presses on the spinal cord or nerves.
  • Thickened ligaments. The tough cords that help hold the bones of your spine together can become stiff and thicker over time. These may then protrude into the spinal canal.
  • Spinal injuries. Car accidents and other trauma can cause dislocations or fractures of one or more vertebrae. Displaced bone from a spinal fracture may damage the contents of the spinal canal. Swelling of nearby tissue immediately after back surgery also can put pressure on the spinal cord or nerves.
  • Tumours. Abnormal growths inside the spinal cord, within the membranes that cover the spinal cord or in the space between the spinal cord and vertebrae. These are uncommon.

What are the symptoms of spinal stenosis?

As your spinal channel narrows, the constricted space can cause the spinal cord or nerves to become irritated, compressed or pinched, resulting in back pain and sciatica. However, you may not have any symptoms for a long time. Depending on where and how severe your spinal stenosis is, you might feel pain, numbing, tingling and/or weakness in your neck, back, arms, legs, hands or feet. You may also have problems with walking and balance.

When should I see a doctor? 

If you have any of the symptoms described above, make an appointment with your GP. 

How is spinal stenosis diagnosed?

Your doctor may ask you about symptoms and carry out a physical examination. Some of the common diagnostic tests used  include; 

  • X-rays: an X-ray can show changes to the bone, such as bone spurs 
  • Magnetic resonance imaging (MRI): an MRI produces cross-sectional images of your spine and can reveal damage to your disks and ligaments, as well as the presence of tumours. It is also effective in identifying where the nerves in your spinal cord are being constricted.
  • CT scan: this test combines X-ray images taken from many different angles to produce detailed, cross-sectional images of your body. In some CT scans a contrast dye is injected which outlines the spinal cord and nerves and can expose herniated disks, bone spurs and tumours.
  • Electroencephalogram (EEG): this test helps to evaluate the condition of spinal nerve.

What are the treatments for spinal stenosis?

Treatment for spinal stenosis depends on the location of the stenosis and the severity of your signs and symptoms.

Mild cases of stenosis may be treated with nonsurgical approaches. A combination of exercise, lifestyle changes, hot and cold treatments, physiotherapy, steroid injections, or pain relief medication can help control your symptoms. 

For advanced stenosis, your doctor may recommend surgery, which may include removal of a small section of bone to relieve pressure (laminectomy). Sometimes, large areas of bone are removed and metal hardware is inserted to provide strength and support for the spine (spinal fusion). Mater Private Network in Dublin is the only Irish hospital to offer robotic-assisted spinal fusion surgery, which improves visualisation and precision during surgery. This has many benefits for patients including smaller incisions, reduced blood loss, and faster recovery 

Lumbar decompression – this involves removal of bone and ligament that has overgrown and is causing pressure on nerves and/or spinal cord. The surgery is normally performed through a keyhole incision, but in cases where there are multiple pinch points a bigger incision is required.