Spinal stenosis is a condition that can cause lower back, buttock, and leg pain. The majority of people with spinal stenosis find symptom relief and improved function with pain management, including medications, therapy, and back bracing for support. Epidural steroid injections place pain relieving and anti-inflammatory medication directly at the source of the pain.
Pain management is helpful for many people. However, pain management treatments cannot correct the structural changes and narrowing in the spine. For a small percentage of people with spinal stenosis, surgery may be necessary.
The opening in the center of each vertebra forms the spinal canal. Your spinal cord is located within the protective spinal canal. The spinal cord extends from the brain and is a major part of your nervous system. The spinal cord does not fill the entire space in the spinal canal. Instead, the spinal cord is surrounded by the epidural space (cavity), which contains tissue, nerves, and blood vessels.
Spinal nerves extend from the spinal cord and exit the lumbar spine through “tunnels” called foramina. The nerves travel to the lower back, buttocks, legs, and feet. The spinal cord and nerves at the lumbar spine send signals for sensation and movement between your brain and lower body muscles. The spinal cord tapers near the first lumbar vertebra and forms a group of nerves called the cauda equina. The cauda equina is involved with regulating bowel and bladder functions.
Prolonged standing or walking may increase your symptoms. Bending forward or sitting may relieve symptoms because these positions increase the room in the spinal canal, taking pressure off the spinal cord.
If the spinal nerves in the lower end of the lumbar spine are compressed, a condition called Cauda Equina Syndrome may result. Cauda Equina Syndrome can cause loss of bladder and bowel control, as well as low back pain, leg pain, leg weakness, lower body sensory deficits, and reduced or absent leg reflexes. If you suspect you have Cauda Equina Syndrome, seek medical treatment immediately.
Your doctor may also order computed tomography (CT) scans or magnetic resonance imaging (MRI) scans to get a better view of your spinal structures. CT scans provide a view in layers, like the slices that make up a loaf of bread. The CT scan shows the shape and size of your spinal canal and the structures in and around it. The MRI scan is very sensitive. It provides the most detailed images of the discs, ligaments, spinal cord, nerve roots, or tumors. X-rays, myelograms, bone scans, CT scans, and MRI scans are painless procedures.
Epidural steroid injections are used to place medicine around the source of pain and inflammation. The medication is injected in the epidural space of the spinal canal. Steroid medication is used to reduce inflammation and relieve pain. Salt water (saline solution) may be added to flush chemicals that cause inflammation.
Pain relief from epidural spinal injections may allow you to participate in physical therapy to help you strengthen your back, stomach, and legs. Persons with weak stomach muscles or spinal degeneration may wear a lumbar brace or corset during activities to provide support. Stretching exercises will help to keep your back flexible. Cardiovascular exercises help to build up your endurance and improve blood circulation to your nerves. This can help to relieve the symptoms of spinal stenosis. Your therapist can also recommend durable medical equipment to aid your safety and activity performance. Such devices could include a cane for walking or a shower chair.
Non-surgical treatments for spinal stenosis are designed to relieve pain and restore function, but they cannot correct the narrowing of the spinal canal. Surgery is recommended when non-surgical treatments have provided minimal or no improvement of your symptoms. Surgery may be advised if your leg weakness becomes progressively worse or if you experience associated bowel and bladder problems. The most common surgeries for spinal stenosis are lumbar laminectomy, also referred to as lumbar decompression surgery, and spinal fusion.
Am I at Risk
Spinal stenosis is more common in people over the age of 50 because of “wear and tear” on the spine associated with the aging process. Spinal stenosis can occur in younger people that are born with a narrowed spinal canal. Certain medical conditions can lead to spinal stenosis, including:
• Arthritis, especially a type of degenerative arthritis called osteoarthritis, can lead to abnormal growths in the spine (bone spurs), as well as disc and facet joint degeneration.
• Spondylolisthesis, a spine condition, results when one vertebra slips forward on another, causing the spinal canal to narrow.
• Acquired spinal stenosis is caused by spinal tumors or abnormal soft tissue growths that extend into the spinal canal or cause swelling.
• Acquired spinal stenosis can also develop when a spinal ligament ossifies.
Ligaments are strong connective tissues that connect bones and joints together. Ossification occurs when calcium deposits form on a ligament and turn it into bone. At the lumbar spine, the posterior longitudinal ligament can cause spinal stenosis if it ossifies and presses on the nerves in the spinal canal.