February 10, 2010
Cleveland_Clinic_Host: Spinal stenosis generally affects middle-aged or elderly adults. Spinal stenosis occurs when bulging discs, arthritic spurs, and thickened tissues combine and causes a narrowing of the lumber (back) or cervical (neck) spinal canal, which leads to the compression of the nerve roots.
Symptoms of this disease include (typically) lower back pain or numbness that may spread to the legs, back, neck, shoulders or arms. As the spinal cord is compressed, it can result in lower extremity weakness and difficulty walking. People with stenosis may also experience headaches, a loss of sensations or muscle weakness. To make an appointment in the Center for Spine Health at Cleveland Clinic Neurological Institute, call toll free at 866.588.2264. You can also visit us online at www.clevelandclinic.org/spine.
Cleveland_Clinic_Host: Welcome to our Online Health Chat. Let’s begin with the questions.
Overview of Spinal Stenosis
nystrom: As you age - can you do anything to prevent spinal stenosis?
Cleveland Clinic physician: Maintaining good spine health, such as regular exercise, weight control, not smoking and healthy diet can help reduce the chances of developing symptoms related to spinal stenosis.
SnowWoman6: What types of treatment should I expect from visiting a pain specialist for my spinal stenosis?
Cleveland Clinic physician: They may prescribe medications or perform epidural steroid injections.
Ohmyachingback10: What are the risks of spinal stenosis surgery and is it safe?
Cleveland Clinic physician: Very safe and routine. Risks include nerve injury, infection, spinal fluid leak and spinal instability.
BryceAve: How long is the recovery period after spinal surgery?
Cleveland Clinic physician: Approximately 6 weeks. Patients typically are up and out of bed the next day after surgery and walking. Most patients typically stay in the hospital 1-3 days after surgery.
Back post-surgical back pain often persists for approximately 6 weeks. These times may be shorter for less invasive techniques or longer for larger decompressive surgeries.
Spinal Stenosis: Is it Genetic?
kajr0210: Is spinal stenosis hereditary? My grandmother and mother both had back surgeries and I have symptoms of spinal stenosis. Is it likely that I'll need surgery too?
Cleveland Clinic physician: Newer studies are showing an influence of genetics in spinal stenosis. Yes - there may be some aspect of inheritance in these degenerative conditions although the magnitude is not clear at this moment.
Just because your family has had surgery does not mean that you will need surgery also. You should exhaust all conservative measures and then be evaluated by a spine surgeon if necessary.
Diagnosing Spinal Stenosis
pamelap: Hello. I am experiencing numbness in both hands and feet. I was diagnosed with Osteoarthritis in my c3 disc about 4 years ago. I have not had any tests done since then (except my doctor sent me for testing for carpal tunnel (right hand). I also have some incontinence-he told me to do kegel exercises. Could this stenosis? Also, should I consult and orthopaedist or neurologist or what?? Please guide me.
Cleveland Clinic physician: Cervical spinal stenosis is often associated with numbness and tingling in the hands and feet, urinary changes and gait imbalance. So, indeed, your symptoms could be related to cervical stenosis.
The diagnosis may be made on physical exam findings which can differentiate carpal tunnel from cervical stenosis and can be confirmed with an MRI. You should be evaluated by a spine physician if the symptoms persist or worsen.
Marge: My mom was diagnosed with spinal stenosis and is losing the ability of movement in her legs, would chiropractic visits help?
Cleveland Clinic physician: If your mother is losing the ability to move her legs, she should be evaluated by a spine surgeon. Chiropractic visits can help alleviate pain associated with lumbar spinal stenosis, but not the neurological findings.
Raydios: Can sporadic cramping of hands and fingers be caused by stenosis in the neck and if so, what are the remedies other than surgery? Thank you.
Cleveland Clinic physician: Yes, cramping can be associated with stenosis in the neck. Occupational and physical therapy can often help this cramping. Epidural injections may also be appropriate.
Raydios: How is stenosis in the neck associated with cramping of hands and fingers and what alternatives to surgery are available?
Cleveland Clinic physician: Cervical stenosis may be associated with decreased coordination, weakness and/or pain in the arms and hands. This may be reported by the patient as "cramping."
Treatments other than surgery include medications, physical and occupational therapy and/or epidural steroid injections.
pamelap: Can occasional numbness in the lips be a symptom of spinal stenosis. Thank you for your answers to my questions.
Cleveland Clinic physician: No. Facial symptoms are related to systemic causes. An example would be low calcium or problems in the brain or brain stem, not the spine.
Cervical Spine Stenosis
cwalker: I am a 51 year old female with cervical spinal stenosis. I was just diagnosed with this condition a few months ago. I began spine med treatments (chiropractor) on my neck and have been doing those for a few months. The pain is not improving. My pain is dull and severe at times. It is better when I am seated. I can walk even a short distance and the pain will begin. Lately, at nights I am having difficulty sleeping for the pain. My questions: 1) Considering that the pain is continuing, would the Cleveland Clinic be a possibility for a second opinion? 2) Is the incontinence I am experiencing related to this condition? 3) Is surgery usually inevitable? 4) Will the cortisone shots relieve the pain? Will they actually improve the condition?
Cleveland Clinic physician: Spinal stenosis typically presents with dexterity changes in the upper extremities, gait imbalance and urinary changes. It can be associated with pain in the arms and neck. If progressive and left untreated, there can be weakness, inability to walk and incontinence.
Yes - if you continue to have pain, you should seek medical attention. You can get a second opinion from Cleveland Clinic either by making an appointment in the Spine Center (866.588.2264) or online.
There is a strong possibility that incontinence is related to the condition and for that reason we recommend that you see a spine physician.
When neurological symptoms related to spinal stenosis is progressive, surgery is most often the only effective treatment available.
Cortisone shots (epidural) can help alleviate arm pain. Epidural injections will not improve the neurological findings but are used solely to treat pain.
cwalker: I am experiencing a lot of pain, since I was diagnosed with Cervical Spinal Stenosis in October. My doctor has suggested 6 cortisone shots in my neck. Is this procedure predominately for pain or will it improve the condition? (The spinal cord is flattened along my cervical spine).
Cleveland Clinic physician: Cortisone shots are typically used to treat the pain associated with spinal stenosis and not the neurological symptoms. However, with improved pain, patients are able to mobilize better, perform physical therapy with much less pain and thus the neurological symptoms may improve from that.
cwalker: You previously answered questions for me. Thank you. I am in pain often. Are there any significant risks with the cortisone series? I know they give an epidural, so it seems risky??
Cleveland Clinic physician: There are known risks with cortisone injections. The risks are low and should be discussed with the interventionist giving you the injections. The risks are significantly lower than those associated with surgery.
Symptoms of Spinal Stenosis
kajr0210: Is it common to experience discomfort in the groin and hip area from spinal stenosis or could this be a symptom of another problem?
Cleveland Clinic physician: It is atypical to experience pain in the groin with spinal stenosis. This is usually associated with a hip problem, but this could be distinguished with a physical exam and possibly a diagnostic injection.
pattayo: I spent the summer, three months, in excruciating pain, had an MRI with the diagnosis of lumbar spinal stenosis, spondylolisthesis, degenerative changes, etc. Then all of a sudden, it started to get better. No one can answer my questions as to why it started when it did and why it got better. Is that the nature of back problems? Thank you for all this helpful advice.
Cleveland Clinic physician: You are exactly right! Back symptoms typically improve on their own. Having flare-ups is not uncommon. We only consider surgery when symptoms become persistent and intractable.
Conservative Therapy: Medications
Teamleary: Besides surgery, are there any other treatment options for elderly patients who do not respond to steroids?
Cleveland Clinic physician: Yes- physical therapy, non-steroidal medications and newer medications to treat nerve pain (Lyrica®, Neurontin®, Cymbalta®) are more often effective for the symptoms related to spinal stenosis.
Surgery is usually the most effective treatment when symptoms become moderate to severe and conservative therapy is not helping. However, not all surgery is the same. Minimally invasive techniques are often used for the elderly to minimize the morbidity of a larger operation.
Treatment Options: Surgery or Conservative Therapy?
pattayo: Is surgery always necessary if you have been diagnosed with spinal stenosis?
Cleveland Clinic physician: No. In reality we operate on a minority of patients with spinal stenosis. Most patients improve with conservative therapy. Surgery is only considered when symptoms become progressive, despite conservative treatment.
pattayo: I have seen two neurosurgeons and they both said that they "like surgery". One would not even discuss any other options.
Cleveland Clinic physician: In some situations surgery is the best option for a given problem, but there are often non-surgical treatments that are available and effective. This should be fully explored before considering an operation. Always consider multiple opinions before undergoing surgery especially if you are uncomfortable with the decision.
pattayo: And if physical therapy makes it worse, as it did for me?
Cleveland Clinic physician: It physical therapy makes it worse, then we either try to change the type of therapy you are receiving or avoid it all together.
pamelap: Also, what is the treatment or "cure" for stenosis IF that's what it is...what tests are done to verify?
Cleveland Clinic physician: When dealing with the spine, very rarely is there a "cure." When symptoms become progressive, surgical decompression is the treatment used to relieve the stenosis. History, physical exam and MRI are used to make the diagnosis. Other tests are usually not necessary.
shatchsr: I have two compressed discs and I have been taking steroid shots which only offer temporary relief. What is the success rate of surgery for this type of problem?
Cleveland Clinic physician: Without knowledge of the location of your pain and why you are receiving epidural injections, I cannot comment on the success of surgery. I would need more information to answer this question. For example: where do you have pain, what type of epidural injections are you receiving?
shatchsr: The compressed discs are the 5th and 6th (I believe) and my pain is centered in my lower back and right leg. The steroid shots are epidurals in the lower back region and I had a series of three so far. What is the success rate of such an operation and how long would I be laid up?
Cleveland Clinic physician: We will assume that you either have a herniated disc or compression of a nerve in your lower back. If the epidural steroid injections gave you relief (even if temporary) the success with the decompression operation is greater than 80%. If the epidural steroid injections did not give you any relief (even if temporary) - the success rate is much lower.
We will assume that you either have a herniated disc or compression of a nerve in your lower back. If the epidural steroid injections gave you relief (even if temporary) the success with the decompression operation is greater than 80%. If the epidural steroid injections did not give you any relief (even if temporary) - the success rate is much lower. Recovery for herniated disk surgery - you are typically in the hospital for 1 day and recovery from surgical pain is approximately 4-6 weeks.
Recovery for herniated disk surgery - you are typically in the hospital for 1 day and recovery from surgical pain is approximately 4-6 weeks.
MortyRunning: Is acupuncture effective in alleviating the pain or symptoms of spinal stenosis?
Cleveland Clinic physician: It may be effective in some patients. It is an alternative treatment. Main stream treatments should be tried first and if not effective, consider acupuncture.
Tracie6799: Can artificial disk replacement surgery be effective for patients with spinal stenosis symptoms?
Cleveland Clinic physician: No.
Gunner: Can chiropractic manipulation relieve the pressure on a nerve caused by lumbar spinal stenosis?
Cleveland Clinic physician: No- only surgery will relieve compression on a nerve. However, chiropractic manipulation can help alleviate the symptoms associated with lumbar stenosis.
FYI: How long can nerve compression continue without causing permanent nerve damage?
Cleveland Clinic physician: This is hard to define and is really not known.
HoleinOne: What are some nonsurgical treatment options for spinal stenosis?
Cleveland Clinic physician: Some common treatments include physical therapy, non steroidal medications & epidural steroid injections.
Vivalasvegas99: How do you prepare for spinal stenosis surgery?
Cleveland Clinic physician: There needs to be a correlation of symptoms with anatomy. For example, with lumbar stenosis the typical symptoms would be: pain, numbness and tingling in the legs with walking and standing.
This then must be correlated typically with MRI findings of compression or narrowing of the space available for the nerves in the lumbar spine.
An adequate trial of conservative therapy is necessary. This typically includes NSAID's and physical therapy. Physical therapy focuses in on lower extremity conditioning and strengthening. If this fails to improve the symptoms after 8-12 weeks, epidural steroid injections are often performed.
Spinal Stenosis: Decompression Surgery
daisy88: Please describe in common terminology what a decompression operation is in regards to spinal stenosis.
Cleveland Clinic physician: In simple terms, the nerves in the spine are surrounded by a ring of bone. In stenosis, this ring is narrowed and compressing the nerves. A decompression involves removing part of the ring (usually the back part). Removing the lamina, or the back part of the ring, gives the compressed nerves more room. Medically this is termed "laminectomy."
daisy88: If I were to have the decompression surgery, generally how long would I be in the hospital and how long would the rehabilitation period be after the hospital stay?
Cleveland Clinic physician: This is a hard question to answer and with your specific problem, but in general, patient's are in the hospital 1-3 days and typically 6 weeks in recovery from the surgical pain is the norm.
Mcdaddy: How effective is it to perform a spinal fusion along with decompressive laminectomy?
Cleveland Clinic physician: Spinal fusion is only needed in a minority of cases of lumbar stenosis, the most common being spondylolisthesis.
Spondylolisthesis is a condition in which one of the bones of the spine (vertebrae) slips out of place onto the vertebra below it. If it slips too much, the bone might press on a nerve, causing pain. Usually, the bones of the lower back are affected.
Spondylolisthesis is the most common cause of back pain in teens. Symptoms of spondylolisthesis often begin during the teen-age growth spurt. Degenerative spondylolisthesis occurs most often after age 40.
Treatment for spondylolisthesis depends on several factors, including the age and overall health of the person, the extent of the slip, and the severity of the symptoms. Treatment most often is conservative, involving rest, medication, and exercise. More severe spondylolisthesis might require surgery.
The word spondylolisthesis comes from the Greek words spondylos-, which means "spine" or "vertebra," and -listhesis, which means "to slip or slide."
Exercise and Spinal Stenosis
kajr0210: What exercises should be avoided for individuals with spinal stenosis? Is running and walking a bad idea?
Cleveland Clinic physician: In general, no exercises should be avoided with spinal stenosis unless, of course, they aggravate your symptoms. If running and walking do aggravate your symptoms, riding an upright exercise bike is an excellent exercise that usually does not worsen the symptoms.
Chefcindy46: I have Spina Bifida Occulta (SBO) with a Transitional Vertebra with Sacralization of the L5-S1(Bertolotti's Syndrome). I have Formical Stenosis, scoliosis, ddd in the areas of L4-L5 and L5-S1. My question is, what is the correlation between SBO and Bertolotti's Syndrome and stenosis and what can be done to stop the progression of symptoms associated with these conditions?
Cleveland Clinic physician: Spina bifida occulta (SBO) and sacralization of a lumbar vertebra are both failures of segmentation during embryologic development. In fact, they are not uncommon. The majority of the time there are no symptoms associated with this.
When there is an incomplete fusion of the transverse process of the lowest lumbar vertebrae to the sacrum and there is pain associated with this, the condition has been termed Bertolotti's Syndrome.
Stenosis is most typically associated with degeneration of the spine - wear and tear - which may have an association with Bertolotti's Syndrome but not with SBO.
You can be evaluated by a spine surgeon to assess if a surgical intervention, injection or physical may be appropriate to treat the symptoms.
chefcindy46: The doctors (Neurologists and Neurosurgeons as well as General MDs) have never heard of Bertolotti's and therefore do not associate my pain and health issues with the BO and state there is nothing that can be done. My condition is worsening and I have tried all other conservative treatments, including the injections, medications (which I am allergic to) and am out of options. What would be my next step?
Cleveland Clinic physician: I have experience treating patients with Bertolotti's Syndrome and have published papers on the condition. I would be happy to evaluate you.
SBMom3: What type of relief can be provided for pain in the tail bone, especially when you sit down early in the morning?
Cleveland Clinic physician: This is most likely not related to stenosis, this may be coccydynia.
The classic symptom of coccydynia is pain when pressure is applied to the tailbone, usually when sitting in a hard chair or surface. Treatment is conservative - non-steroidal anti-inflammatory drugs (NSAIDs) -- such as ibuprofen and naproxen -- to reduce inflammation, and the use of a therapeutic sitting cushion to take the pressure off of the tailbone when sitting. It might take many weeks or months of conservative treatment before significant pain relief is felt.
Cauda Equina Syndrome (CES)
Reader4567: What is the most effective treatment to relieve symptoms related to Cauda Equina Syndrome?
Cleveland Clinic physician: Emergent surgery is the only treatment of cauda equine syndrome. This condition is a medical emergency.
The cauda equina are nerve roots at the end of the spinal cord which resemble a horse’s tail. Cauda Equina Syndrome (CES) occurs when the nerve roots are compressed causing a disruption of motor and sensory functions to the lower extremities and bladder. It may be commonly due to a massive herniated disc. CES can lead to incontinence and permanent paralysis if not treated.
Making an Appointment
mittsmurr: What should I be doing to prevent further damage to my spine? I have spinal stenosis - lower back bulging discs - some deterioration - using heat - therapy pool haven't walked a lot but have a large house to care for with many steps so can do most everything I want to. Better than a few months ago. (I have had trouble since wallpapering 5 bedrooms in two weeks - back in 2007) If I make an appt with a doctor at the clinic - do I need to have my family doctor do this in order for Medicare to pay? I couldn't afford to pay myself since I am rather low income - Thank you.
Cleveland Clinic physician: If you have had an MRI or CT scan within the past year from your primary care doctor, you could be sent immediately to a surgeon. If you have not had an MRI or CT within the past year from your primary care doctor, you should have an appointment with one of our spine physicians (who would then be the referral to the surgeon) prior to seeing a surgeon. Either route you take will be covered by Medicare and the scheduling department will guide you through which route you need to take. You can call 216.636.5860 or 866.588.2264 to get the process started and make the first appointment.
- To make an appointment with Dr. Steinmetz in the Center for Spine Health at Cleveland Clinic Neurological Institute, call toll free at 866.588.2264. You can also visit us online at www.clevelandclinic.org/spine.
- A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult Web site. To request a remote second opinion, visit eclevelandclinic.org/myConsult.
- If you need more information, contact us, chat online or call the Center for Consumer Health Information at 216.444.3771 or toll-free at 800.223.2272 ext. 43771 to speak with a Health Educator. We would be happy to help you. Let us know if you want us to let you know about future web chat events!
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.