Spinal stenosis fundamentals
With age, the spinal canal – located in the lower back – can narrow, resulting in spinal stenosis. The narrowing process, which is gradual, reduces the space available for the spinal cord and nerves. If only a small amount of spinal narrowing occurs, no pain will result. Spinal stenosis may lead to leg pain, numbness, and/or tingling. In advanced cases, weakness may also be present.
What causes spinal stenosis?
Spinal stenosis occurs when bulging discs, arthritic spurs, and thickened tissues combine to "compress" the nerves traveling through the spinal canal.
The most common symptom of spinal stenosis is pain, numbness and/or tingling in legs that is pronounced when standing or walking. Leg pain and numbness may inhibit walking and the spine may lose the lumbar curve and appear flat. Because we tend to bend over slightly when we walk up hill, symptoms may be less going uphill and worse going down. Relief is typically found when you bend forward or sit. When spinal stenosis becomes severe, symptoms may become constant and permanent nerve injury may result.
Spinal stenosis typically occurs among older adults, and arthritis and injuries can also cause the spinal cord to narrow.
What are treatment options for spinal stenosis?
- Taking non-steroidal anti-inflammatory drugs (NSAIDs) for relief.
- Receiving cortisone injections directly into the spinal column to provide short-term relief.
- Engaging in exercise and physical therapy that focuses on strengthening the back and abdominal muscles as well as stretching.
If the above treatment options do not ease the pain and your ability to engage in everyday activities is inhibited, you should consider spine surgery.
The goal of spinal stenosis surgery is to permanently decompress the spinal canal.
Types of spine surgery:
- Laminectomy: The most common type of surgery for this condition, laminectomy involves the removal of the lamina, a portion of the vertebra, to make room for the nerves. Some ligaments and bone spurs may also be removed. The surgery requires making an incision into the back.
- Foraminotomy: The foramen is the area in the vertebrae where the nerve roots exit. The procedure involves expanding this area to provide more space for the nerve roots.
- Spinal fusion: This procedure is done in cases of instability and involves joining the bones together with screws or bone grafts to provide spinal stability. It may be combined with laminectomy surgery. The surgery lasts several hours and can be done using one of two methods:
- Bone is removed from elsewhere in the body or obtained from a bone bank. This bone is used to create a bridge between vertebrae and stimulates the growth of new bone.
- Metal implants, such as rods, hooks, wires, or screws, are secured to the vertebrae to hold them together until new bone grows between them.
What are the risks of surgery for spinal stenosis? Is the surgery safe?
Risks of spinal stenosis surgery include nerve injury, infection, bleeding, and stiffness.
How do I prepare for spinal stenosis surgery?
To prepare for spine surgery, quit smoking if you smoke, exercise on a regular basis to improve your recovery rate, stop taking any non-essential medications and any herbal remedies which may react with anesthetics or other medications and ask your surgeon all the questions you may have.
What happens after spinal surgery?
Pain may persist for a few days after surgery, requiring the use of pain medications and NSAIDs to reduce swelling. However, your doctor will likely recommend a light form of exercise right after spinal surgery to insure that the back does not stiffen and to reduce swelling.
Taking hot showers and using hot compresses may help alleviate pain. Additionally, the use of an ice pack may ease pain before and after exercise.
How long is the recovery period after surgery?
Full recovery after surgery for spinal stenosis typically takes three months and possibly longer for spinal fusion, depending partially on the patient's progress in rehabilitation and the severity of the surgery.
What is the rehab after spinal stenosis surgery?
After spine surgery, your doctor will likely prescribe walking and strengthening exercises for the lower back and abdomen to help stabilize the spine.
What are the CCF physician credentials?
- All doctors at Cleveland Clinic Center for Spine Health are fellowship-trained and board-certified or board-eligible in orthopaedic surgery, medical spine or neurosurgery. In addition, our surgeons have subspecialty training and years of experience in spine surgery.
- All Cleveland Clinic staff radiologists are board-certified or board-eligible in radiology or have the international equivalent.
- All Cleveland Clinic staff rehabilitation specialists are board-certified or board-eligible in physical medicine and rehabilitation, or have the international equivalent.
- All Cleveland Clinic staff pain management specialists are board-certified or board-eligible in pain management or have the international equivalent.
What clinical trials are being conducted at CCF on spinal stenosis?
Researchers at Cleveland Clinic are involved in ongoing studies that investigate new drugs and treatment approaches for managing disease. Participants in these clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. There are currently more than 1,700 active clinical studies underway.
Are there other resources that I can go to for more information on spinal stenosis?
Patients can go to the following resources for more information on this procedure:
- Cleveland Clinic Health Information Center
- American Academy of Orthopaedic Surgeons
- North American Spine Society
- Spine Universe Website
Why should I seek a second opinion regarding treatment for spinal stenosis?
As modern medical care grows more complex, patients can feel overwhelmed. The opportunity to consult a recognized authority about a particular diagnosis and treatment can bring peace of mind at an emotionally difficult time. A second opinion may be beneficial when:
- You are uncertain about having surgery.
- You still have questions or concerns about your current treatment.
- A controversial or experimental treatment is recommended.
- You have multiple medical problems.
- You have choices to make about treatment.
A convenient way to obtain a second opinion is e-Cleveland Clinic, a contemporary adaptation of Cleveland Clinic’s 80-year tradition as a nationally designated referral center. An easy-to-use, secure, from-home second opinion service, e-Cleveland Clinic utilizes sophisticated Internet technology to make the skills of some of our specialists available to patients and their physicians, anytime, anywhere. With e-Cleveland Clinic’s personalized access, no patient need ever to feel unsure or uninformed when faced with what could potentially be one of the most important decisions of their life.