Sherri O’Connor, PA-C
Stenosis is a medical term that simply means narrowing. Narrowing can arise from a herniation and/or arthritis of the spine. This narrowing physically pinches the nerves. This then creates nerve irritation, inflammation and can affect the function of the nerve. Patients may experience radiating pain away from the spine towards the extremities. It is common to experience numbness in an extremity, maybe just a toe or finger, or tingling into the extremity. Not everyone will complain of neck or back pain with a diagnosis of stenosis. Symptoms of stenosis can present as numbness, tingling, cramping, burning, pain or even weakness. Sometimes a patient will experience difficulty when walking, neurogenic claudication. Symptoms might improve with stopping, sitting or leaning forward. If the cervical spine is involved, a patient might complains of weakness into the hands and dropping items. It can begin as simple numbness or difficulty with small activities of daily living. In the extreme case stenosis can lead to loss of bowel or bladder function or even paralysis.
There are many treatment options in the presence of stenosis. All begin with an accurate history and physical exam. The treatment of stenosis works to improve function and decrease inflammation. Anti-inflammatories, therapy, and activity modification are the initial modalities used. Many times this will resolve nerve pain; improve function and quality of life. Sometimes an epidural steroid injection is done. This is an x-ray guided injection of “cortisone.” While this will not cure the anatomic aspect of stenosis, it can impact the symptoms and function that patients experience. Many patients will have satisfactory relief after a single injection, while others might require more than one. An MRI can help to guide treatment by assisting with the assessment of the magnitude of stenosis and location. It can also provide some insight into how successful an injection might be. If all other measures fail, surgery might be an option. Surgery can physically enlarge the space for the nerves, and can be done through a variety of techniques including minimally invasive surgery.
© O’Connor “Back Pain: Common Diagnosis and Treatment”