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The spinal cord and the nerves that link the brain to the trunk and limbs are protected within the bones of the spinal column. Traveling downward in a bony canal the nerves emerge at multiple levels, sending messages throughout the body.
Due to congenital deformities or other medical conditions such as arthritis, this canal may become smaller leading to progressive tightness around the nerves. This is usually a very slow process that may be asymptomatic for years because the nerves are surrounded and cushioned by a liquid, the spinal fluid.
Since spinal stenosis is much more common in the lumbar spine, most symptoms are related to pain in the back and legs. Patients may note that the farther they walk, the more their legs feel heavy or weak; eventually the person has to stop and rest prior to resuming walking, a condition called spinal claudication.
The pain is usually mild to moderate at first but may increase over months and years. Burning, tingling and shooting pains in the limbs may occur, as well as aching in the back and legs.
The only permanent treatment for spinal stenosis is surgery. Unfortunately, surgery is not always the best treatment choice since it is a difficult procedure with certain risks. Most patients with spinal stenosis are 65 or older, and many have other medical problems that may complicate surgery.
Alternatives to surgery include the use of drugs to reduce pain and sometimes narcotic analgesics may be needed. Since the spinal nerves and the brain are made from the same basic materials, the pain may also respond to the same drugs used to treat depression and seizures. Less informed patients sometimes refuse those medications erroneously assuming that “the doctor thinks it’s all in my head.”
Physical therapy is of limited value unless there are accompanying problems that limit the patient’s physical functions. A light exercise program to maintain the muscle tone and balance is recommended, and water exercises are often well tolerated.
Nerve blocks can be very useful in the early stages of spinal stenosis. Epidural steroid injections are the most common type of block used and consist of the introduction of medications into the spinal canal. The injection technique is similar to that used during childbirth to alleviate pain, with the exception that cortisone, also known as steroids, is injected along with a local anesthetic. It may provide weeks or even months or temporary pain relief, and it often improves walking endurance. Repeat injections are usually required, but as the disease advances these blocks may become less effective.
Even though spinal stenosis is a progressive disorder, it worsens at a very slow pace giving the body time to adjust. Most patients remain functional for decades, but care has to be exercised as falls or other accidents may exacerbate an otherwise stable condition, sometimes causing a permanent worsening of the symptoms.