Spinal Stenosis

Diagnosis

To diagnose spinal stenosis, your healthcare professional may begin by asking about your symptoms and reviewing your medical history. A physical examination is often performed to assess movement, nerve function and areas of pain. Imaging tests are usually needed to confirm the diagnosis and identify the cause of nerve compression.

Imaging tests may include the following:

• X-rays
An X-ray of the spine can show bone changes, such as bone spurs, that may be narrowing the spinal canal. Each X-ray uses a small amount of radiation.

• Magnetic resonance imaging
MRI uses a powerful magnet and radio waves to produce detailed images of both hard and soft tissues. This test can show damage to disks and ligaments and can detect tumors or other causes of spinal canal narrowing.

• Computerized tomography
If you are unable to have an MRI, a CT scan may be recommended. This test combines X-ray images taken from multiple angles to create detailed cross-sectional views. A CT myelogram, which involves injecting contrast dye, can outline the spinal cord and nerves and help identify herniated disks, bone spurs or tumors.

Treatment

Treatment for spinal stenosis depends on how severe your symptoms are and how much they interfere with daily activities. Options range from medicines and physical therapy to minimally invasive procedures and surgery.

Medicines may be prescribed to help relieve pain and other symptoms. These can include:

• Nonsteroidal anti-inflammatory drugs
Prescription NSAIDs may be used if over-the-counter pain relievers do not provide enough relief.

• Antidepressants
Low nightly doses of certain antidepressants, such as amitriptyline, can help reduce chronic pain.

• Anti-seizure drugs
Medications like gabapentin are sometimes used to relieve pain caused by irritated or damaged nerves.

• Opioids
Strong pain medicines such as oxycodone may be used in some cases, but they carry a risk of dependence and are usually considered carefully.

Physical therapy can play an important role in treatment. A physical therapist may teach exercises that help:

• Build strength and endurance
• Maintain flexibility and spinal stability
• Improve balance

Steroid injections may be used if nerve roots are inflamed or swollen due to compression. Injecting a steroid medication near the affected nerve can reduce swelling and temporarily relieve pain. However, steroid injections may not always be effective and can cause side effects. Repeated injections can weaken nearby bones, tendons and ligaments, so they are usually spaced several months apart.

Needle procedures for thickened ligaments may be an option for some people. If the ligament in the lower spine becomes too thick, needlelike tools can be inserted through the skin to remove part of the ligament. This helps create more space in the spinal canal and reduce pressure on nerve roots. Sedating medicine may be given, and many people can return home the same day.

Surgery may be recommended when other treatments do not provide enough relief. Surgical procedures aim to create more space within the spinal canal and reduce pressure on nerves. These procedures can include:

• Laminectomy
This surgery removes the back portion of the affected vertebra, called the lamina, to relieve nerve pressure. In some cases, nearby bones are stabilized using metal hardware and bone grafts.

• Laminotomy
Only part of the lamina is removed to relieve pressure in a specific area.

• Laminoplasty
Performed only in the neck, this procedure creates more space by forming a hinge in the lamina and holding it open with metal hardware.

In many cases, surgery helps reduce symptoms of spinal stenosis. However, some people may continue to have symptoms or experience worsening afterward. Possible surgical risks include:

• Infection
• Blood clots forming in leg veins
• Tears in the membrane covering the spinal cord

Talk with your healthcare team about the potential benefits and risks of each treatment option to determine the approach that is best for you.