Consider these spinal stenosis treatments before committing to surgery

Tingling fingertips, dropping things more frequently, lower back pain and weakness in the feet—these are just a few things that could be considered a minor, non-emergent nuisance. They could also be symptoms of spinal stenosis, a narrowing of the space around the spinal canal and nerve roots.

Spinal stenosis can occur anywhere throughout the spine. It can be caused by an overgrowth of bone or other tissue or by a herniated disc, and the process is typically gradual. When the spinal canal gets too narrow, it can squeeze and irritate the spinal cord or nearby nerve roots.

“The decision on whether to operate comes down to each individual patient and what their level of activity is, desired level of function, and what interference their symptoms are causing in their daily activity level and whether it’s impacting their overall quality of life”. -Dr. Bryan Wohlfeld

Spinal stenosis symptoms

When someone is born with a narrower-than-average spinal canal, they may have more symptoms than someone with a wide spinal canal. For example, some people born with congenital spinal stenosis can become symptomatic from other things that can crowd the space around the spinal cord, like bone spurs or disc herniations says Dr. Wohlfeld.

Generally, most people who have spinal stenosis develop symptoms when they’re 50 years old or older.

The symptoms of spinal stenosis can vary depending on the location and severity of the compression on the spine, but common signs are back or neck pain and difficulty walking or maintaining balance.

Symptoms often worsen over time and may be worsened by certain activities such as walking or standing and improve with rest or changes in position. Dr. Wohlfeld states they can also differ based on the area affected by the narrowing.

• In the neck, spinal stenosis can lead to difficulty using hands, clumsiness, numbness, weakness, balance trouble and spasticity.
• Narrowing around nerve roots can cause pain or numbness and weakness of muscles connected to the affected nerve.
• In the thoracic spine, spinal stenosis can cause difficulties walking, rotating the torso and moving side to side. Sharp pain in the back radiating to the lower back and legs, leg aches or discomfort, and pain in the internal organs are some other potential symptoms.
• In the lower back, symptoms can affect the ability to stand or walk, and can result in back or leg pain as well as numbness.

What causes spinal stenosis?

The majority of individuals with spinal stenosis develop the condition over time. Causes include, but aren’t limited to:

• Arthritic changes
• Degenerative discs
• Herniated discs
• Thickened ligaments
• Bone overgrowth
• A buildup of fat or other tissues that line the back of the spinal canal which can sometimes thicken or harden

How do you diagnose spinal stenosis?

Dr. Wohlfeld uses various tools to diagnose spinal stenosis and rule out other conditions, including, but not limited to, patient history, a physical exam and imaging tests. Each tool helps make a diagnosis by looking for signs of spinal stenosis.

The first step is recognizing if there is a history of spinal stenosis symptoms. Then, healthcare teams will use X-rays to look for degenerative changes and signs of instability or reversal of the spine’s normal curvatures.

If the patient’s symptoms have failed to improve with nonsurgical treatment, an MRI will be obtained to see what is causing the stenosis, where the stenosis is occurring, and what kind of treatments can be options for it.

When left untreated, spinal stenosis can result in permanent damage to the spinal cord and lead to further complications. It is important to adjust any treatment plans as necessary based on symptom progression and collaboration between the patient and healthcare specialists says Dr. Wohlfeld.

Why explore nonsurgical options first?

Exploring nonsurgical options for spinal stenosis can provide effective relief without the risks and recovery time associated with surgery, and many people with mild spinal stenosis find these treatments relieve symptoms and help them remain active.

Physical therapy, assistive devices, lifestyle modifications and pain management are always a good place to start for reducing some of the pain caused by spinal stenosis.

These nonsurgical options do that by strengthening the person’s core, improving flexibility and posture, maintaining a healthy weight, improving circulation, relieving muscle tension and more. Experts can also help patients find appropriate assistive devices like seat cushions and walking aids.

In the end, the decision about whether to operate comes down to each patient:

• What is their level of activity?
• What is the desired level of function?
• How are their symptoms interfering in daily activity?
• Is it impacting their overall quality of life?

What are the surgical treatments for spinal stenosis?

Surgical procedures are aimed at the specific problems causing spinal stenosis and can involve:

• Moving bone from behind the spinal canal
• Taking out bulging discs or bone spurs from the front in the neck
• Trying to restore the lost height of the disc and thereby decompressing the canal Laminectomies, or instrumented infusions, to try to stabilize portions of the spine or decompress them

Some procedures can be done through minimally invasive techniques, and it’s important for patients to talk to their surgeons about their options. This can help them better understand how the procedure may address their concerns and what to expect while healing.

Exciting technology continues to emerge at IU Health Bloomington, opening opportunities for patients with spinal stenosis. This includes a new procedure where surgeons can replace joints in the spine that allow motion and stabilization and let the provider remove the abnormal joint without needing to do a fusion says Dr. Wohlfeld.

This new advancement will be an option for IU Health Bloomington Neurosurgery patients in the near future.