Why does the spinal canal narrow?
Over time, discs lose height and bulge, facet joints enlarge with arthritis, and the ligament lining the back of the canal (ligamentum flavum) thickens. Together these changes crowd the space where nerves travel. Stenosis can also be accompanied by spondylolisthesis, a slipped vertebra.
Symptoms
Lumbar stenosis
- Pain, cramping, numbness or heaviness in the buttocks and legs when standing or walking (neurogenic claudication)
- Relief when sitting or leaning forward, as on a shopping cart
- Gradually shorter walking distances
Cervical stenosis
Narrowing in the neck can compress the spinal cord itself, causing hand clumsiness, trouble with buttons or handwriting, and balance problems. This is called cervical myelopathy and should be evaluated promptly.
Diagnosis
Dr. Ferachi reviews your symptoms and exam, and confirms the level and severity of narrowing with MRI (or CT myelogram if MRI isn't possible). Standing X-rays, including flexion and extension views, show whether the spine is unstable, which affects which surgery is best.
Treatment
Mild to moderate stenosis is often managed with physical therapy, walking programs, medication and epidural steroid injections. These don't widen the canal but can control symptoms for long periods.
When walking tolerance and quality of life keep declining, surgery is highly effective. A lumbar laminectomy or decompression removes the bone and ligament pressing on the nerves. If the spine is unstable or a vertebra has slipped, decompression is combined with minimally invasive fusion. Cervical stenosis is treated with anterior or posterior cervical decompression.
Common questions
Does spinal stenosis get worse over time?
It is usually slowly progressive, but many people stay stable for years. Cervical stenosis that affects the spinal cord is different and is more likely to progress, so it deserves closer monitoring.
What is the success rate of surgery for spinal stenosis?
Decompression surgery reliably improves leg pain and walking distance for most well-selected patients. Dr. Ferachi will discuss expected results based on your imaging, health and goals.