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Spinal Stenosis
What is spinal stenosis?
Spinal stenosis is a medical term for what happens when the spaces within your spine narrow, putting pressure on the spinal cord and nerves that run through it. This narrowing can occur in different parts of the spine but predominantly affects the cervical (neck) and lumbar (lower back) regions. It typically develops gradually over time and might not cause symptoms until the narrowing becomes quite significant.
The spine comprises a series of bones (vertebrae) stacked on top of one another, with discs between each vertebra that provide cushioning. The spinal cord runs through a canal in the centre of this vertebral column, with nerves branching off and extending to other body parts. When the spaces in the spinal canal narrow (stenosis), it can compress these nerves, leading to various symptoms.
There are two main types of spinal stenosis:
- Central stenosis: central stenosis occurs when the spinal canal becomes narrowed. It typically affects the lumbar spine (lumbar spinal stenosis) and can lead to symptoms such as lower back pain, leg pain, numbness, weakness, or difficulty walking (claudication).
- Foraminal stenosis: foraminal stenosis occurs when the neural foramina, which are the openings through which spinal nerves exit the spinal cord and travel to the rest of the body, becomes narrowed. It can lead to compression or irritation of the spinal nerves as they exit the spinal canal, causing symptoms such as neck pain, arm pain, shoulder pain, numbness, tingling, or weakness in the arms or hands (cervical foraminal stenosis), or lower back pain, buttock pain, leg pain, numbness, tingling, or weakness in the legs or feet (lumbar foraminal stenosis).
What causes spinal stenosis?
Several factors can contribute to the development of spinal stenosis, mainly linked to the ageing process and the wear and tear on the spine that occurs over time. Causes of spinal stenosis include:
- Degenerative spinal changes: age-related degeneration of the spine is one of the most common causes of spinal stenosis. Over time, the intervertebral discs lose hydration and elasticity, the facet joints experience wear and tear, and the spine’s ligaments may thicken. These changes can lead to bulging discs, herniated or slipped discs , bone spurs, or thickening of the ligaments, all contributing to the narrowing of the spinal canal or neural foramina.
- Osteoarthritis: osteoarthritis is a condition characterised by the breakdown of cartilage in the joints, which affects the facet joints of the spine. This can lead to bone spurs, inflammation, and enlarged facet joints, all of which can encroach on the spinal column, resulting in stenosis.
- Tumours: though rare, abnormal growths can occur within the spinal canal, compressing the nerve roots and spinal cord.
- Trauma: injuries to the spine can lead to fractures or dislocations that add pressure to the spinal cord or nerves, leading to spinal stenosis.
- Congenital abnormalities: some individuals may be born with congenital abnormalities of the spine that predispose them to spinal stenosis. Examples include congenital narrowing of the spinal canal (congenital stenosis), abnormalities of the vertebral arches (such as spina bifida), or spinal canal or neural foramina malformations.
These factors can reduce the amount of space available for the spinal cord and nerves, leading to the symptoms associated with spinal stenosis.
What are the symptoms of spinal stenosis?
Not everyone with spinal stenosis will experience symptoms, and if symptoms do occur, they are often progressive and worsen over time. Symptoms of spinal stenosis vary depending on where they occur; common symptoms include:
- Pain: pain in the neck or back that radiates to the extremities. The pain may be dull, aching, or sharp and may worsen with certain activities.
- Numbness, tingling, or weakness: compression of the spinal nerves can cause numbness, tingling, muscle weakness, and poor coordination. These sensory disturbances may occur unilaterally (affecting one side of the body) or bilaterally (affecting both sides) and may worsen with prolonged standing or walking.
- Claudication: neurogenic claudication is a hallmark symptom of lumbar spinal stenosis and refers to pain, cramping, or weakness in the legs that occurs with walking or standing and improves with rest or sitting. This symptom is typically relieved by bending forward or sitting down and may be accompanied by numbness or tingling in the legs.
- Bowel or bladder incontinence: in severe cases of spinal stenosis, problems with bladder or bowel control may occur, indicating a need for immediate medical attention.
These symptoms can significantly impact the quality of life, making everyday activities challenging.
Is spinal stenosis painful?
Yes, spinal stenosis can be quite painful, especially when it results in nerve compression. The degree of pain varies among individuals and can range from mild discomfort to severe, debilitating pain. Activities that stretch or compress the spine can exacerbate the pain, making it difficult to engage in normal daily tasks without discomfort.
Who is at risk of spinal stenosis in Singapore?
While spinal stenosis can affect anyone, certain factors increase the risk, including:
- Age: the risk of spinal stenosis increases with age. As people age, the intervertebral discs lose hydration and elasticity, the facet joints experience wear and tear, and the spine’s ligaments may thicken. These age-related degenerative changes can contribute to the narrowing of the spinal canal or neural foramina and increase the risk of spinal stenosis.
- Genetics: genetic factors may play a role in determining an individual’s susceptibility to spinal stenosis. Certain genetic conditions or inherited traits, such as congenital abnormalities of the spine, collagen disorders, or structural abnormalities, can affect spinal development and increase the risk of spinal stenosis.
- History of spinal injuries: individuals with previous spinal injuries may be at higher risk of developing spinal stenosis.
- Lifestyle factors: a sedentary lifestyle, obesity, and physically demanding jobs can contribute to the development of spinal stenosis.
How is spinal stenosis diagnosed?
Diagnosing spinal stenosis typically involves a combination of the following:
- Medical history and physical examination: your pain specialist will inquire about the symptoms, duration, and onset of pain. Additionally, a physical examination of the spine and neurological assessment will be performed to evaluate range of motion, posture, muscle strength, sensation, reflexes, and signs of nerve compression or irritation. Specific manoeuvres, such as the straight leg raise test (for lumbar stenosis) or Spurling’s test (for cervical stenosis), will be conducted to reproduce or exacerbate symptoms and assess for signs of nerve root compression.
- Imaging tests: imaging tests, including X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans, may be utilised to identify areas of spinal narrowing and nerve compression.
- Diagnostic tests: additional diagnostic tests such as electromyography (EMG), nerve conduction studies, or provocative discography may be performed to assess nerve function, identify areas of nerve compression or irritation, or differentiate spinal stenosis from other spinal conditions.
What are the treatment options for spinal stenosis in Singapore?
The treatment options for spinal stenosis aim to alleviate symptoms, reduce inflammation, improve spinal function, and enhance quality of life. Treatment choice depends on factors such as the severity of symptoms, the location of the stenosis, the individual’s overall health, and their treatment preferences. Treatment for spinal stenosis may include:
- Medications: medications, including over-the-counter and prescription pain relievers, can manage pain and inflammation associated with spinal stenosis.
- Epidural steroid injections: epidural steroid injections are administered directly into the affected area, providing targeted pain relief and reducing inflammation associated with spinal stenosis.
- Facet joint injections: facet joint injections may be used to alleviate pain originating from the facet joints of the spine.
- Assistive devices: assistive devices such as a cane or walker can help support balance and stability while walking and reduce the risk of falls in individuals with spinal stenosis.
- Lifestyle modifications: modifying activities that exacerbate symptoms, such as heavy lifting, bending backwards, or prolonged standing or walking, can help reduce spinal compression and alleviate symptoms associated with spinal stenosis.
Treatment choice depends on the underlying cause of the neck pain, its severity, and the individual’s overall health and preferences. Individuals need to consult a pain specialist to determine the most appropriate treatment plan for their specific condition. If you are suffering from neck pain, schedule an appointment with us for a thorough diagnosis and an appropriate treatment plan.
Frequently asked questions
The optimal treatment for spinal stenosis varies; it often involves a combination of physical therapy, medication, and minimally invasive pain interventions.
While spinal stenosis cannot be “fixed” or cured completely, many treatment options can effectively manage symptoms and improve quality of life. Surgical and non-surgical treatments can relieve pressure on the spinal cord and nerves, addressing symptoms.
While spinal stenosis cannot be “fixed” or cured completely, many treatment options can effectively manage symptoms and improve quality of life. Surgical and non-surgical treatments can relieve pressure on the spinal cord and nerves, addressing symptoms.
Yes, non-surgical treatments such as physical therapy, medications for pain and inflammation, weight loss, exercise, and pain interventions may help manage spinal stenosis symptoms without the need for invasive surgical procedures.
Total Pain Specialist