Spinal stenosis

Spinal stenosis is a narrowing (stenosis) of the spinal canal. Depending on how narrow the canal is, the spinal cord and nerve roots can be damaged.

The spine is made up of several interconnected vertebrae. Most vertebrae have a hole in the middle – the vertebral foramen. Together, the vertebral foramen form the spinal canal, through which the spinal cord runs, and the roots of the spinal cord nerves (spinal nerves) branch off from this.

Spinal stenosis most commonly occurs in the lumbar spine in the lower back or in the cervical spine in the neck. If the lumbar spine is affected, doctors refer to this as lumbar spinal stenosis and talk of cervical spinal stenosis if it’s in the neck area.

Lots of older people have spinal stenosis, caused by wear and tear.

This does not always cause problems. Sometimes, however, the narrowing of the spinal canal causes symptoms such as pain, impaired sensation or paralysis. This then requires treatment.

Very often, spinal stenosis does not cause symptoms. Symptoms only occur when the spinal canal is so severely narrowed that nerves, nerve roots or blood vessels are compressed.

The symptoms are also dependent on whether it is the cervical spine (neck) or the lumbar spine (lower back) that is affected.

When the spinal canal in the cervical spine is narrowed, neck pain radiating to the arms usually occurs. The person may also experience dizziness. If the spinal cord is damaged by the narrowing, it can also cause impaired sensation or numbness in hands, arms and legs over time.

Narrowing of the spinal canal in the lumbar spine area often manifests itself as chronic pain in the lower back, some of which radiates to the buttocks and legs. Prolonged standing or walking usually intensifies the pain. They usually improve when sitting or bending forwards.

Some people with stenosis in the lumbar spine show a characteristic gait known as a “pain-related limp”. Sometimes, there is also impaired sensation and paralysis in the legs.

Spinal stenosis can also lead to bladder or bowel emptying problems, such as incontinence.

The most common cause of spinal stenosis is signs of wear and tear of the spine, such as on intervertebral discs and the zygapophyseal joints (small vertebral joints). The wear and tear is usually age-related. It’s very rare for spinal stenosis to be present at birth.

Accident or fall-related injury to the spine, especially in the neck region, can also lead to stenosis if a broken piece of bone is pushed into the canal. The causes include, for example:

• Traffic accidents
• Sports accidents, such as when diving
• Falls, especially in the case of elderly people

Other possible causes include:

• Infection-related inflammations of the intervertebral discs (discitis) or the bones and bone marrow (osteomyelitis)
• Chronic inflammatory joint diseases such as rheumatoid arthritis
• Metabolic diseases such as Cushing’s syndrome, where hormonal changes affect the stability of the vertebral body.
• Bone diseases such as Paget’s disease, where an increased rate of bone renewal in individual, local areas in the body, results in dense, but unstable bone.

There are no exact numbers of how many people have spinal stenosis.

As wear and tear is a common cause for the narrowing, the likelihood increases with age.

Studies suggest that around 5 in 1,000 people between 50 and 65 years of age develop spinal stenosis. 

In the over-65 age group, spinal stenosis is the most common reason for surgery on the spine.

To diagnose spinal stenosis, you first of all need to have an in-depth conversation with your doctor about your existing symptoms and an intensive physical examination.

Doctors check for the following in particular:

• whether and which sensory disturbances are present
• how flexible you are and how good your reflexes are
• to what extent and in what form your gait is impaired
• whether pain occurs as a result of damaged nerve roots

To confirm the diagnosis, doctors usually use magnetic resonance imaging (MRI). This imaging procedure helps identify where and how severely the spinal canal is narrowed.

If it is not possible to use MRI, computed tomography (CT) is used as an alternative.

Various treatment options are available depending on the cause and severity of spinal stenosis. They range from exercises to the administration of medication and surgery.

If causes such as an infection or tumors are ruled out and if there are no signs of spinal cord injury, conservative therapy is usually adequate, i.e. physiotherapeutic or drug treatment. These include, for example:

• Movement exercises in the pain-free region and muscle training
• Taking non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants
• Infiltration: this is where a local anesthetic and an anti-inflammatory drug like cortisone are injected into the spine.

If conservative treatment measures do not provide adequate help or if there is injury to the spinal cord or nerve roots, a surgical procedure can be considered.

The surgery usually involves surgeons removing bony parts of one or more vertebral joints to widen the spinal canal and reduce pressure on the nerves. This procedure is also called decompression.

As this procedure can lead to the spine losing stability, the adjacent vertebrae are often joined together at the same time. So far, however, it has not been proven that this method, known as fusion, has any advantages.

Surgery should generally only take place if it is absolutely necessary. Studies suggest that 10 to 24 of every 100 spinal stenosis operations on the lower back result in complications that sometimes lead to permanent physical impairments.

Recovering from spinal stenosis and regaining mobility is often a long and difficult road, especially after surgery.

For successful rehabilitation, it is important that a team from the areas of medicine, physiotherapy and ergotherapy work closely together.

The more comprehensive and diverse the care is, the better the chances of a full recovery.