Spinal Stenosis

To diagnose spinal stenosis, your doctor may ask you about signs and symptoms, discuss your medical history, and conduct a physical examination. He or she may order several imaging tests to help pinpoint the cause of your signs and symptoms.

Imaging Tests

These tests may include:

• X-rays.An X-ray of your back can reveal bony changes, such as bone spurs that may be narrowing the space within the spinal canal. Each X-ray involves a small exposure to radiation.
• Magnetic resonance imaging (MRI).An MRI uses a powerful magnet and radio waves to produce cross-sectional images of your spine. The test can detect damage to your disks and ligaments, as well as the presence of tumors. Most important, it can show where the nerves in the spinal cord are being pressured.
• CT or CT myelogram.If you can’t have an MRI, your doctor may recommend computerized tomography (CT), a test that combines X-ray images taken from many different angles to produce detailed, cross-sectional images of your body. In a CT myelogram, the CT scan is conducted after a contrast dye is injected. The dye outlines the spinal cord and nerves, and it can reveal herniated disks, bone spurs and tumors.

Treatment

Treatment for spinal stenosis depends on the location of the stenosis and the severity of your signs and symptoms.

Talk to your doctor about the treatment that’s best for your situation. If your symptoms are mild or you aren’t experiencing any, your doctor may monitor your condition with regular follow-up appointments. He or she may offer some self-care tips that you can do at home. If these don’t help, he or she may recommend medications or physical therapy. Surgery may be an option if other treatments haven’t helped.

Surgery

Surgery may be considered if other treatments haven’t helped or if you’re disabled by your symptoms. The goals of surgery include relieving the pressure on your spinal cord or nerve roots by creating more space within the spinal canal. Surgery to decompress the area of stenosis is the most definitive way to try to resolve symptoms of spinal stenosis.

Examples of surgical procedures to treat spinal stenosis include:

• This procedure removes the back part (lamina) of the affected vertebra. A laminectomy is sometimes called decompression surgery because it eases the pressure on the nerves by creating more space around them.

In some cases, that vertebra may need to be linked to adjoining vertebrae with metal hardware and a bone graft (spinal fusion) to maintain the spine’s strength.

• This procedure removes only a portion of the lamina, typically carving a hole just big enough to relieve the pressure in a particular spot.
• This procedure is performed only on the vertebrae in the neck (cervical spine). It opens up the space within the spinal canal by creating a hinge on the lamina. Metal hardware bridges the gap in the opened section of the spine.
• Minimally invasive surgery.This approach to surgery removes bone or lamina in a way that reduces the damage to nearby healthy tissue. This results in less need to do fusions.

While fusions are a useful way to stabilize the spine and reduce pain, by avoiding them you can reduce potential risks, such as post-surgical pain and inflammation and disease in nearby sections of the spine. In addition to reducing the need for spinal fusion, a minimally invasive approach to surgery has been shown to result in a shorter recovery time.

In most cases, these space-creating operations help reduce spinal stenosis symptoms. But some people’s symptoms stay the same or get worse after surgery. Other surgical risks include infection, a tear in the membrane that covers the spinal cord, a blood clot in a leg vein and neurological deterioration.