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Spinal Stenosis

Spinal stenosis is a narrowing of areas in the lumbar (back) or cervical (neck) spine, which causes pressure on the spinal cord or one or more of the spinal nerves. It may be caused by a number of things including:
- Arthritis involving the spine, usually in middle-aged or elderly people
- Herniated or slipped disk
Injury that causes pressure on the nerve roots or the spinal cord itself
- Defect in the spine that was present from birth (congenital defect)
- Tumors in the spine
- Paget's disease of bone
- Achondroplasia

Most often, symptoms will be on one side of the body or the other and will include: numbness, cramping, or pain in the back, buttocks, thighs, or calves, or in the neck, shoulders, or arms, weakness of a portion of a leg or arm.

Symptoms are more likely to be present or get worse when you stand or walk upright. They will often lessen or disappear when you sit down or lean forward. Most people with spinal stenosis cannot walk for a long period of time.

More serious symptoms include:
Difficulty or imbalance when walking
Problems controlling urine or bowel movements
Problems urinating or having a bowel movement

In order to pinpoint the location of the pain and figure out how it affects your movement, a physical exam will be given by the doctor. Patients may be asked to: sit, stand, and walk, bend forward, backward, and sideways, lift legs straight up while lying down. If the pain is worse when you do this, you may have sciatica, especially if you also feel numbness or tingling in one of your legs.

Your doctor will also move your legs in different positions, including bending and straightening your knees. All the while, the doctor is assessing your strength, as well as your ability to move.

To test nerve function, the doctor will use a rubber hammer to check your reflexes. Touching your legs in many locations with a pin, cotton swab, or feather tests your sensory nervous system (how well you feel). Your doctor will instruct you to speak up if there are areas where the sensation from the pin, cotton, or feather is duller.

A brain/nervous system (neurological) examination can confirm leg weakness and decreased sensation in the legs. The following tests may be done: EMG, spinal MRI or spinal CT scan, X-ray of the spine.

Even when your back pain does not go away completely, or if it gets more painful at times, learning to take care of your back at home and prevent repeat episodes of your back pain can help you avoid surgery. Your doctor and other health professionals are partners with you to manage your pain and keep you as active as possible.

Generally, conservative management is encouraged. This involves the use of medications, physical therapy, and lifestyle changes.

If the pain is persistent and does not respond to these measures, surgery is considered to relieve the pressure on the nerves or spinal cord. Surgery is performed on the neck or lower back, depending on the site of the nerve compression.

Many people with spinal stenosis are able to carry on active lifestyles for many years with the condition. Some change in activities or work may be needed.

Spine surgery will often provide full or partial relief of symptoms. However, future spine problems are still possible after spine surgery. The area of the spinal column above and below a spinal fusion is more likely to be stressed when the spine moves. Also, if you needed more than one kind of back surgery (such as laminectomy and spinal fusion), you may be more likely to have future problems.