Spinal Stenosis: Causes, Symptoms, and Treatments (from Therapy to Surgery)

Spinal Stenosis, the narrowing of the spinal canal, is a common cause of back pain in adults and is the leading reason that American adults seek back surgery (1). Approximately 11% of American adults, or 200,000 people each year, are affected by spinal stenosis, however many of those affected lack information on their condition (2,3). This article discusses some of the common causes of spinal stenosis, symptoms to watch out for, and treatment options to help your back feel better. It will also outline when to seek care from a Spine Surgeon. For further information on spinal stenosis or available treatments, please consult with a licensed healthcare professional.

Typically, spinal stenosis is a degenerative process, meaning it results from the gradual breakdown of body tissues over long periods of time. Often, this process begins with breakdown of the intervertebral discs that separate and cushion the bones of the spine, leading to increased strain on the facet joints that help to coordinate movement between adjacent bones of the spine. Over time, increased strain leads to the formation of new bone and scar tissue that narrows the spinal canal itself, leading to back pain and pressure on the spinal cord.

Rarely, spinal stenosis may result from cancer, either of the spine or metastasizing from another primary tumor, or from other primary disease of the spine. Patients with a history of smoking, obesity, or family histories of spinal stenosis may be at increased risk. In all cases, patients with signs of spinal canal narrowing should seek evaluation from a medical professional to rule out rare but dangerous causes of disease.

First line treatment for spinal stenosis in the absence of red flag symptoms is conservative management involving physical therapy and activity modifications (3). NSAIDs (eg. ibuprofen/Advil™, naproxen/Alieve™, etc) are frequently used to help control pain, though evidence is mixed regarding their effectiveness. Epidural corticosteroid injections can provide meaningful short term relief but do not address the underlying disease process. Though commonly used, other over-the-counter or supportive pain medications (acetaminophen, gabapentin) have not shown benefit compared to placebo for reducing pain caused by spinal stenosis.

For patients with symptoms that persist despite modifications to activity and pain support, decompression surgery can provide meaningful improvement in function and pain (4). In the absence of a rare clinical emergency, spinal stenosis progresses slowly. As such, surgery is typically elective.