Do you find yourself bending forward when you stand for long periods of time or walk for short distances because of back pain? Or do you have a tingling sensation or pain that radiates from your neck down your arms? Many people think that this is a normal part of aging, but sometimes it is caused by a pinched nerve in the spine. In medicine, we call this spinal stenosis. Don't worry, today we will talk about everything in simple terms.
What is Spinal Stenosis?
Simply put, spinal stenosis is a narrowing of the space inside our spine. Think of our spine as a series of rings (called vertebrae) stacked on top of each other. Each ring has a space in between, like a tunnel. This tunnel is called the spinal canal . The spinal cord, a very important part of our body, and the nerves that branch out from it, travel through this tunnel.
Now think about it, what happens if this tunnel narrows for some reason? Just like when a water pipe gets clogged, the space for water to flow decreases, when this spinal canal narrows, there is not enough space for the spinal cord and nerves inside. Then those nerves start to get squeezed, pinched, and pressured. It is because of that squeezing that we get symptoms like back pain and pain that goes down the legs (sciatica).
Although this condition can occur at any age, it is most common among people over the age of 50 .
Which parts of the spine are most affected by this condition?
This nerve compression is usually seen most often in two places in the spine:
- Lumbar Spinal Stenosis: A condition that occurs in the lower five vertebrae (L1-L5) of our spine. This is the most common type of back pain.
- Cervical Spinal Stenosis: This condition can occur in the seven vertebrae (C1-C7) in our neck.
In addition to these two, this condition can also occur in the middle of the spine, that is, at the thoracic spine level. However, it is very rare.
What are the symptoms of this?
Spinal stenosis often develops slowly over time. So, even though it can be seen on an X-ray, you may not have any symptoms in the early stages. Symptoms can vary from person to person. Some days it may be worse, while others may be better.
In general, depending on where the nerve is pinched, you may feel things like this in your neck, back, arms, legs, palms, or soles of your feet:
- Pain
- Numbness
- Tingling / "pins and needles"
- Weakness
Let's see how the symptoms differ in cases of spinal and neck stenosis.
| Type of symptom | Description |
|---|---|
| Symptoms of Lumbar Spinal Stenosis | |
| Back pain | Pain in the lower back. |
| Pain that travels down the legs | Pain that starts in the buttocks and travels down the leg, sometimes all the way to the sole of the foot. |
| Heaviness and cramping in the legs | Feeling of heaviness in the legs, feeling like your legs are going numb after walking for a short while, and cramps. |
| Numbness | Tingling or a feeling of ants running in the buttocks, legs, or soles of the feet. |
| Times when the pain increases and decreases | The pain increases when standing for a long time, walking, or going down a hill. The pain decreases when bending forward, sitting in a chair, or climbing stairs/hills. (For example, bending forward, like when pushing a trolley at the supermarket, reduces back pain.) |
| Symptoms of Cervical Spinal Stenosis | |
| Neck pain | Neck pain. |
| Numbness and weakness | Feeling of tingling or weakness in the arms, hands, legs, or soles of the feet. |
| Problems with body balance | Difficulty maintaining balance while walking. |
| Problems with fine motor skills of the hands | Difficulty performing fine tasks such as writing by hand, buttoning a shirt, or holding a cup. |
Why does spinal stenosis occur?
There are two main categories of reasons for this.
1. Acquired causes: This is the most common cause. This condition occurs due to changes in our body ("wear and tear") that occur with age.
2. Congenital causes: Some people are born with a narrowed spinal canal. This is quite rare.
Main causes that occur with age (Acquired Causes)
- Bone Overgrowth: As we age, our joints wear down. This is called osteoarthritis. When the joints in the spine wear down, the body responds by growing new bone. These new bone spurs can grow into the spinal canal and press on the nerves.
- Bulging or herniated discs: Between each vertebra in our spine, there is a jelly-like cushion. We call these discs. As we age, these discs become dry, flattened, and can develop cracks in their walls. Then the jelly-like part inside can bulge out (bulging or herniated disc) and press on the nerves.
- Ligaments thickening: Ligaments are the band-like structures that connect our spine. Due to conditions like arthritis, these ligaments can thicken over time and bulge into the spinal canal, reducing the space for the nerves.
- Injuries to the spine: This canal can also become narrowed due to an accident such as a fracture or sprain in the spine.
- Tumors: Very rarely, a tumor in or around the spine can also cause nerve compression.
How do you find this, Doctor?
When you go to see a doctor with these symptoms, he will first ask you about your symptoms. Then he will do a physical examination. He will bend your spine in different directions and pay attention to how the pain occurs.
In addition, we may recommend several tests to pinpoint the problem:
- X-ray of the spine: This can detect changes in the bones, loss of disc height, and bone spurs.
- MRI scan (Magnetic Resonance Imaging): This is the best way to clearly see delicate things like nerves, discs, and spinal cord.
- CT scan (Computed Tomography): This is a test that provides more detailed images than an X-ray. Sometimes a CT myelogram, which uses a special liquid (contrast dye), may also be done.
What are the treatments for this?
When people hear the name, they often think, "Oh, will I have to have surgery?" But not everyone with spinal stenosis needs surgery. Many people can get better with nonsurgical treatments. The best treatment for you will depend on the severity of your symptoms, the location of the problem, and the cause.
| Treatment method | Description |
|---|---|
| Nonsurgical Treatments | |
| Things you can do at home | Heat/Cold packs, appropriate exercises as directed by a doctor. |
| Medications | NSAIDs to reduce pain and swelling. Sometimes medications like gabapentin for nerve pain. But remember, you should always ask your doctor before using any medication. |
| Physical Therapy | Provide good support to the spine through exercises that strengthen the back and abdominal muscles. Practice walking postures that reduce pressure on the nerves. |
| Steroid Injections | Injections given to reduce swelling and pain around the pinched nerve. |
| Surgery | |
| When is surgery recommended? | Surgery is only considered when all other treatments have failed and the symptoms are very severe. |
| Main types of surgeries | Laminectomy: Removing part of the vertebra to provide more space for the nerves. Spinal Fusion: If the spine is unstable, fusing two vertebrae together. This is considered a last resort. |
Are there ways to avoid this situation?
While we can't completely stop the aging process, there are some things we can do to keep our spine healthy. These can help reduce the risk of spinal stenosis or control its progression.
- Healthy diet: Eat foods rich in calcium to keep bones strong.
- Maintaining a healthy weight: As body weight increases, the pressure on the spine increases.
- Avoid smoking: Smoking damages our blood vessels, which can increase back pain.
- Maintaining correct posture: It is very important to keep your back straight when sitting, standing, and lifting weights.
- Regular exercise: Exercises that strengthen the back and core muscles, especially the abdominal muscles, can help keep the spine healthy.
When should I see a doctor?
If you have new back or neck pain, along with numbness or weakness in your arms or legs, be sure to see a doctor. If you are already taking treatments and they are not helping, see your doctor to discuss other options.
Emergency!
If you suddenly experience incontinence, or if you feel like both legs are going numb, it is an emergency. In such a case , go to a hospital's Emergency Department (ETU) immediately.
Back and neck pain can be a huge obstacle to our daily lives. But the good news is that there are many effective treatments for it. So instead of ignoring the symptoms, talk to your doctor to find the solution that works best for you.
Take-Home Message
- Spinal stenosis is a narrowing of the spinal canal that occurs with age.
- The main symptoms are pain, numbness, and weakness in the back, neck, arms, or legs.
- In cases of stenosis in the lower back, a common symptom is that the pain decreases when bending forward.
- Many people can achieve good results with non-surgical treatments, such as exercise, physical therapy, and medication.
- Surgery is only necessary in severe cases that have not responded to other treatments.
- If you have these symptoms, be sure to see a doctor for a proper diagnosis and treatment.
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