Spinal stenosis is a neurological condition associated with a narrowing of the spinal canal where the spinal cord runs through. This causes pressure on the spinal cord and the affected individual will present with various neurological signs and symptoms depending on where the narrowing occurs in the spine. The most common area for stenosis to occur is in the lumbar (lower back) region of the back but it can also affect the cervical spine (neck area).

Signs and symptoms of spinal stenosis in the neck include:

• Weakness in an arm, hand, leg, or foot.
• Numbness or a tingling sensation in the mentioned areas.
• Neck pain.
• Problems with balance and walking.
• Loss of bowel or bladder control in severe cases.

The clinical picture in those with stenosis in the lower back may include:

• Weakness in a leg or foot.
• Tingling or numbness is a leg or foot.
• Back pain.
• Cramping or pain in one or both legs when standing for long periods of time or when walking. This usually gets better when bending forward or sitting as the vertebral spaces open.

The causes of spinal stenosis may include:

• Bone spurs forming in the spinal canal due to wear-and-tear damage as a result of chronic inflammatory processes (osteoarthritis).
• Herniation of the gel-like material from inside vertebral discs may press on the spinal cord or the nerve roots.
• Thickening of the ligaments holding the spinal bones in place can bulge into the spinal canal and press on the cord.
• Fractures caused by trauma may result in fragments of bone that may penetrate and damage the spinal cord.
• Post-surgical swelling of nearby tissues may cause cord compression.
• Tumors forming inside the spinal cord can cause compression of the cord but these are uncommon occurrences.

Management

The therapy used to manage the spinal stenosis in affected individuals will depend on the cause of the problem, the location of the pathology, and the severity of the signs and symptoms experienced.

In less severe cases of spinal cord stenosis, the management of the problem will include the following therapies:

Lifestyle changes and home remedies

• Maintaining a healthy weight by becoming physically active and incorporating dietary changes.
• Improving stability and gait by making use of assistive walking devices such as a walker or a cane.
• Applying cold compresses or ice packs to affected areas to help reduce any swelling. Warm compresses will also help to improve the blood flow around the pathological area and this can also help reduce symptoms.

Medications

• Pain relieving medications such as acetaminophen and anti-inflammatories.
• Narcotics such as codeine and morphine.
• Antidepressants such as duloxetine and amitriptyline.
• Anticonvulsants such as pregabalin and gabapentin.

Physical therapy

• To help improve the strength of the muscles that surround the area of stenosis.
• Improves stability and flexibility of the spine.
• Improves balance.

Spinal injections

• Nerve roots may become swollen and irritated where the compression occurs. Steroids and local anesthetic agents can be injected into the space around the nerve entrapment (medial branch block) or into the facet joints if they are inflamed (facet joint injection).
• These are relatively safe and effective forms of therapy that help to reduce symptoms for weeks and even months.