Spinal stenosis

Spinal stenosis--a narrowing of the spinal canal--was first recognized in the late 1950s and has received considerable medical attention since then. Degenerative changes in the spine are the most frequent cause of spinal stenosis, which usually affects people in their 50s and 60s and is about twice as common in men as in women. As the body ages, gradual deterioration of the disks and facet joints in the spine causes the bones to rub together. This increased friction may eventually lead to the formation of osteophytes at the facet joints and around the rims of the vertebrae.

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Spinal stenosis most often occurs when these overgrowths of bone gradually narrow the central canal of the spine (central stenosis) or the bony canals through which nerves leave the spinal cord (lateral stenosis). Ligaments may thicken and cause narrowing of the spinal canal as well. Central narrowing causes symptoms owing to compression of the spinal cord or the cauda equina. Narrowing of the exit canals causes pain owing to compression of the nerves branching off from the spinal cord or interruption of their blood supply. Spinal stenosis may also result as a complication of surgery, trauma to the spine, or involvement of the spine in Paget's disease.

Symptoms of spinal stenosis usually start slowly and are mild at first.

Central stenosis can cause back pain, but usually the pain radiates into both legs. The pain does not follow the distribution of specific nerves but rather seems to involve the buttocks, thighs, calves, and occasionally, the entire length of both legs. The pain is cramping in nature and may be associated with weakness, a "rubbery" feeling, numbness, and a sensation of loss of power in the legs. As a result of this weakness, people are prone to falls. Because the nerves controlling the bladder emerge from the lower spine, spinal stenosis may also cause urinary incontinence.

Bed rest may increase spinal stenosis pain by exaggerating the natural curve of the lower back, which puts more pressure on the spinal cord. Individuals with spinal stenosis may feel more comfortable when sitting in a forward-leaning position.

Lateral stenosis may develop alone or accompany central stenosis. The characteristic symptom of nerve entrapment due to lateral stenosis is severe pain along the path of the affected nerve. The pain from lateral stenosis is not relieved by bed rest, and the affected individual may pace the floor at night or keep changing positions while sitting.