Washington University spinal neurosurgeons routinely treat spinal stenosis – the narrowing of the enclosed space in the spine – in both the neck (cervical stenosis) and low back (lumbar stenosis). They provide a full range of treatment options including conservative (non-surgical) measures and surgical decompression.
Conditions & Treatments
The spinal cord and nerve roots travel in an enclosed space in the spine, called the spinal canal, which is located behind the main weight-bearing part of the spine. Spinal stenosis refers to a narrowing of this space with subsequent compression of the spinal cord and/or nerve roots. Its causes can be:
- Degenerative — wear and tear on the spine over time, with bulging discs, arthritic joints and thickened ligaments all protruding into the spinal canal, narrowing the space available for the spinal cord and/or nerve roots, resulting in acquired spinal stenosis.
- Congenital — a narrow spinal canal that is present from birth. Although congenital stenosis does not cause problems by itself, it makes the spinal cord and/or nerve roots more susceptible to acquired stenosis.
When spinal stenosis causes few, if any symptoms, observation or conservative treatments are recommended. Any symptoms, such as pain, should warrant a comprehensive evaluation by a spine surgeon.
In the low back, spinal stenosis often causes neurogenic claudication, or compression of the nerve roots. Typically, the patient with symptomatic spinal stenosis will have pain, numbness, and weakness in the legs, or some combination of these symptoms, all of which get worse with standing and walking and then are relieved by rest or sitting. Lumbar stenosis tends to be slowly progressive, with more limitations each year. Treatment of lumbar stenosis in the early stages often consists of physical therapy and epidural injections. Treatment of more advanced lumbar stenosis often involves a surgery to decompress the nerves. Most commonly, this is accomplished with a laminectomy, in which the roof of the spinal canal is removed to relieve the compression. This is often performed as outpatient surgery. Your spine surgeon will discuss the various conservative and surgical options after reviewing your specific condition.
Spinal stenosis in the neck (cervical stenosis) is, in general, a more serious problem than spinal stenosis in the low back (lumbar stenosis), as stenosis in the neck may affect the spinal cord, causing myelopathy.This can cause an often painless weakness or numbness of the arms and leg and progressive clumsiness of the hands and during walking. Once symptomatic, cervical stenosis typically requires surgery to decompress the spinal cord. Depending on the number of spinal levels involved, surgery may be from the front of the neck or from the back of the neck.
The Spine Division handles more than 2,100 spinal consults annually.