I was diagnosed with spinal stenosis, now what?

Throughout my career as a physical therapist, I've heard this question so many times that I felt it was worthy of this article. Stenosis is also one of the more misunderstood spinal diagnoses.

In Greek, stenosis means "a narrowing." Spinal stenosis, then, is a narrowing of your spinal canal, the area where your spinal cord and nerves roots travel through. When these areas become narrower, your spinal cord and nerves can get pinched and squeezed. Physicians often call this "compression." The amazing thing about spinal stenosis is that it may not cause you pain. The channels may narrow (stenosis), but they may not press on a nerve root or your spinal cord. No pressing means no pain.

Many years ago spinal stenosis was called creeping paralysis because it gradually got worse as you got older. Most people thought that once it started, there wasn't much you could do to stop it. This was just thought to be another part of growing older. We now know that patients have treatment options, when it comes to spinal stenosis.

The most common cause of spinal stenosis is osteoarthritis, where the cartilage that cushions joints starts to degenerate because of age. The risk of developing spinal stenosis increases in people over age 60. Other causes of spinal stenosis are bulging discs, herniated discs, bone spurs (osteophytes) or injuries to the spine. Some people can be born with spinal stenosis, although, this is not very common. According to the American Association of Neurological Surgeons, "There are as many as 1.2 million Americans with back and leg pain related to spinal stenosis." Risk factors include aging, poor posture, high impact sports and being overweight.

Your symptoms depend on where your spinal canal is narrowed. It is most common in the low back (lumbar) or neck (cervical). It is not as common to have stenosis in your mid back (thoracic). Symptoms of lumbar (low back) stenosis are cramping or pain in your legs when you stand or walk for long periods. The symptoms gradually diminish when you lean forward (example: leaning on a shopping cart in the store) or sit down. Symptoms return when you stand up straight and walk. Other symptoms include numbness, tingling, or weakness in the leg or foot. In severe cases, you can have problems controlling your bowel or bladder. If this happens, seek immediate medical attention. Cervical (neck) stenosis can cause these same symptoms in the neck, shoulders and down the arms. It can also cause headaches and affect your balance, leading to falls.

The good news, according to Dr. Stewart Eidelson, orthopedic surgeon and professor at the University of Miami, is that less than 5 percent of patients with a spinal disorder ever require spine surgery. Your physician will help you determine which option is best for you. Nonsurgical options often include a combination of medication, injections and physical therapy. Aquatic therapy is often the most beneficial form of exercise, as this decreases the compression on the spine.

Some patients may require spine surgery to treat the symptoms caused by spinal stenosis. The goal of the surgery is to relieve the pressure on the nerve root or spinal cord. This is done by enlarging the spinal canal or foramen through which the nerves pass. The type of surgical procedure performed will depend on the type, location and cause of the spinal stenosis. Your doctor should take sufficient time to explain any and all surgical or nonsurgical options with you.