Stenosis

Stenosis means narrowed or narrowing. In the spine it generally means that something is too tight and is causing pressure on nervous structures such as the spinal cord or the nerve roots. Stenosis can have many causes like disc herniations, bone spurs, overgrown ligaments, cysts, and tumors. Althought the incidence of stenosis is not known, it does seem to be increasing in frequency with our aging population. Stenosis does seem to run in families, suggesting that genetics play a role in who will be affected.

Stenosis can occur just about anywhere in the spine, but is most commonly divided into lumbar stenosis and cervical stenosis. In both areas, the underlying problem is the same, the space available for the spinal cord and nerves is decreased. When compression of the nerves or spinal cord becomes significant enough, symptoms begin. The symptoms can often differentiate between lumbar stenosis and cervical stenosis.

Lumbar stenosis clasically presents with a decreased ability to walk or stand upright. Patients typically describe a "stop and go" lifestyle in which they must stop to sit or bend over periodically in order to relieve their symptoms. Typical symptoms include pain in the buttocks and/or thighs which can range from a feeling of numbness to a burning sensation or even stabbing pains. The symptoms worsen as the individual stands for a longer period of time or walks, and are generally made better within a few minutes of bending over or sitting down. Often the affected person will describe having to lean on something in order to walk any distance. The classic example is that of leaning on the shopping cart whenever one goes to the store. These symptoms are referred to as claudication.

Cervical stenosis has quite a different presentation as in the neck, the spinal cord is being compressed rather than the nerve roots. When the spinal cord is compressed, some of the regulatory function over the reflexes is lost which generally makes the reflexes overactive. Some reflexes which are not normally seen in people can begin to manifest themselves. In addition to increased reflexes, patients will generally describe a loss of balance and coordination. They will say that they are dropping things more frequently, or that their handwriting or typing ability has worsened. As the stenosis worsens, walking can even become difficult as the nerves controlling balance are compromised. The diagnosis given to these symptoms is called myelopathy.