What is Spinal Stenosis? 

Spinal stenosis is a condition characterized by the narrowing of spaces within your spine, which can put pressure on the nerves that travel through it. This narrowing most commonly occurs in your lower back (lumbar spinal stenosis) and your neck (cervical spinal stenosis). According to the Cleveland Clinic, degenerative spinal changes affect up to ninety-five (95%) of people over fifty years old (50) making it a significant concern for aging populations. Spinal stenosis is one of these degenerative changes. 

Understanding the Anatomy

Your spine consists of a series of vertebrae or small bones that are stacked or aligned on top of each other. Your spinal canal runs through these vertebrae, housing the spinal cord and nerve roots. These thirty-three (33) bones protect the delicate structures of your spinal cord and nerves. In spinal stenosis, this canal narrows, potentially irritating or compressing these vital neural structures. 

Causes and Risk Factors

Several factors can contribute to the development of spinal stenosis:

• • Age-Related Changes: As you age, your spine naturally undergoes wear and tear.

• • Bone Overgrowth: Osteoarthritis can lead to bone spurs, which can grow into your spinal canal.

• • Herniated Discs:Soft cushions between your vertebrae can bulge and compress nerves.

• • Thickened Ligaments:  Ligaments that hold the spine together can become stiff and thickened over time.

• • Spinal Injuries: Trauma from accidents or sports injuries can damage your spine and lead to stenosis.

If severe spinal stenosis is left untreated, it can potentially lead to permanent numbness or even paralysis. This emphasizes the importance of an early diagnosis and treatment by a spinal stenosis specialist like neurosurgeon, Ricky Kalra, M.D.  

Symptoms and Diagnosis

The symptoms of spinal stenosis can vary depending on the location and severity of the narrowing. Common signs include: 

• • Back pain or neck pain
  • Numbness or tingling in your extremities
  • Weakness in legs or arms
  • Balance problems 

If you are experiencing these symptoms, especially if are over fifty (50) years old or have a history of back problems, it is crucial to consult with a spinal stenosis specialist like Dr. Kalra. Your spine surgeon will perform a thorough examination, including imaging tests such as MRIs or CT scans to diagnose spinal stenosis and recommend appropriate treatment options. 

Causes of Spinal Stenosis 

Age-Related Changes

Spinal stenosis is often a result of the natural aging process. As we grow older, wear and tear damage in the spine related to arthritis becomes more common. This can lead to the formation of bone spurs that push into the spinal canal, reducing the available space. Additionally, the ligaments that stabilize the spine may thicken over time, further narrowing your spinal canal. 

Herniated Discs and Other Conditions 

Herniated discs can also contribute to spinal stenosis. When the soft inner material of a disk leaks out, it can press on the spinal cord or nerves, causing compression. In rare cases, tumors forming inside the spinal canal can also lead to stenosis.

Congenital Factors and Injuries

Some individuals are born with a naturally smaller spinal canal, increasing their risk of developing spinal stenosis later in life. Spinal injuries from an accident or trauma can also lead to stenosis by causing bones to fracture or move out of place, or by creating swelling that puts pressure on the spinal cord or nerves. These factors illustrate the importance of early diagnosis and intervention in spinal stenosis symptoms. 

Other Contributing Factors

Certain medical conditions can also increase the risk of developing spinal stenosis. Paget’s disease of bone, which causes abnormal bone growth, can alter spaces in the spinal canal. Ossification of the posterior longitudinal ligament, is where calcium deposits turn the ligament into a bone like structure. This process may result in narrowing of the spinal canal or nerve root compression. Understanding these diverse causes can help manage back pain and develop effective treatment strategies for spinal stenosis symptoms. 

Diagnosing Spinal Stenosis: Tests and Procedures 

When diagnosing spinal stenosis, a comprehensive approach is essential for an accurate evaluation and effective treatment planning. Spine surgeons will employ a combination of physical examinations, medical history reviews, and various diagnostic tests to confirm the presence of spinal stenosis. 

Physical Examination and Medical History

The diagnostic process typically begins with a thorough physical examination. During this assessment doctors look for telltale sings of spinal stenosis, such as:

• • Loss of sensation
  • Muscle weakness
  • Abnormal reflexes

Imaging Tests

To obtain an image of your spine’s structure, spine surgeons often recommend imaging tests. A few of the most commonly utilized imaging studies utilize in diagnosing spinal stenosis are: 

1. X-rays: These can reveal bone changes that may be narrowing the spinal canal. 

2. Magnetic Resonance Imaging (MRI): This advanced imaging technique provides detailed views of soft tissues, including discs, and ligaments. 

3. Computerized Tomography (CT): When an MRI is not possible, or a detailed picture of the bones is needed a CT scan can be utilized.

These tests help spine surgeons visualize any narrowing of the spinal canal, bone spurs, or other abnormalities that may be causing your symptoms. 

Additional Diagnostic Procedures

In some cases, further testing may be necessary to confirm the diagnosis or rule out other conditions. Additional procedures that may be recommended are:

• • Bone scans
  • CT myelograms (CT scans with injected dye)
  • Nerve conduction studies/electromyography (EMG) 

These tests can provide valuable information about nerve function and help pinpoint the exact location and severity of spinal stenosis. Remember, a diagnosis of spinal stenosis is not solely based on imaging results. A spine surgeon should consider your symptoms, what is generating your pain,  and your overall health when determining the best course of action for your back or neck pain. 

Common Symptoms of Spinal Stenosis 

Spinal stenosis, a condition that can significantly impact your quality of life, and manifests itself through various telltale signs. Understanding these symptoms is crucial for early detection and proper management. As a patient, recognizing these signs can help you seek timely medical attention from a spine specialist such as Dr. Kalra. 

Pain and Discomfort

The hallmark symptom of spinal stenosis is often pain, which can vary in intensity and location. You may experience:

• • Back or neck pain that radiates to your buttocks and legs
  • Burning sensations or numbness in your arms or legs
  • Weakness in your arms and hands, buttocks, legs, and or feet

These symptoms typically worsen with prolonged activities such as standing or walking and may alleviate when you sit or bend forward or rest. 

Neurological Symptoms

As spinal stenosis progresses it can affect your nervous system, leading to more severe symptoms listed below. In some cases, you might experience a loss of sexual ability, or in severe instances, issues with bowl or bladder control. 

• • Tingling or pins and needles sensations in your extremities 
  • Loss of sensation in your feet or hands
  • Foot drop, a condition where weakness causes your foot to slap down when walking

Impact on Daily Activities

Spinal stenosis can significantly affect your daily life. You may find yourself avoiding certain activities or experiencing difficulty with:

• • Walking long distances
  • Standing for extended periods
  • Climbing stairs
  • Balance
  • Fine motor skills

Understand these symptoms is the first step in managing spinal stenosis. If you are experiencing these signs, it is essential to consult with a spinal stenosis specialist to discuss potential treatment options, which may range from non-surgical conservative approaches to more advanced neurosurgical techniques for more severe cases. 

Risk Factors for Developing Spinal Stenosis 

Understanding the risk factors of spinal stenosis can help you take proactive steps to maintain your spinal health. While some factors are out of our control, others can be managed to reduce the likelihood of developing this condition. 

Age Related Changes

The most common cause of spinal stenosis is the natural aging process. As we grow older the ligaments in our spine may thicken and calcify, leading to a narrowing of your spinal canal. This gradual wear and tear on the joints, often associates with osteoarthritis, becomes more prevalent after the age of fifty (50). 

Genetic and Congenital Factors

Some individuals are born with a naturally narrower spinal canal, predisposing them to spinal stenosis. Conditions like congenital stenosis, scoliosis, and achondroplasia can increase the risk. If you have a family history of these conditions, it is essential to discuss this your spine surgeon. 

Medical Conditions

Certain medical conditions can contribute to the development of spinal stenosis. These conditions can cause inflammation, bone growth, or misalignment that narrows the spinal canal.

• Rheumatoid arthritis 
• Paget’s diseases of bone
• Spinal tumors
• Ossification of the posterior longitudinal ligament

Lifestyle Factors

Your daily habits can also impact your risk of developing spinal stenosis. Being overweight puts additional stress on your spine, while smoking can accelerate disc degeneration. Maintaining a healthy weight, exercising regularly, and practicing good posture can help reduce your risk. 

Previous Spine Injuries or Surgeries

A history of spinal injuries or previous spine surgeries can increase your chances of developing spinal stenosis. If you experienced trauma to your spine, or had a previous spinal procedure, it is essential to follow up with your healthcare provider regularly. Understanding these factors and working with your doctor to develop a personalized plan for potentially preventing or delaying the onset of spinal stenosis may help decrease your long term pain or suffering. 

Treatment of Spinal Stenosis

Non-Surgical Treatments for Spinal Stenosis

When it comes to managing spinal stenosis, there are several non-surgical options available to alleviate symptoms and improve quality of life. These treatments can be particularly beneficial for patients with mild to moderate cases of spinal stenosis, or for those patients who are not candidates for surgery. Some potential non-surgical treatment options include:

• • Medication management
  • Physical therapy and exercise
  • Epidural or facet steroid injections
  • Lifestyle modifications 
  • Alternative therapies 

Surgical Treatments for Spinal Stenosis 

When conservative treatments fail to provide relief, surgical intervention may be necessary for patients with severe spinal stenosis. The goal of a surgical procedure to treat spinal stenosis is to alleviate pressure on the spinal cord and nerves, potentially improving pain, numbness, and mobility. Decompression surgeries are the most common surgical approach for spinal stenosis as they aim to create more space within the spinal canal by removing bone or soft tissue. The most common decompression spine surgery options are: 

• • Laminectomy: Removal of the lamina (back part of the vertebrae).  

• • Laminotomy: Partial removal of the lamina. 

• • Foraminotomy: Widening of the neural foramen (where nerves exit spine). 

Decompression procedures may be performed individually or in combination. In cases where spinal instability contributes to stenosis, spinal fusion may be recommended in addition to a decompression. In a spinal fusion two vertebrae are connected or linked together to reinforce your spine’s stability, and to prevent movement between them. 

Understanding spinal stenosis is essential for effective treatment and management. While this condition can be challenging, numerous treatment options exist to alleviate symptoms and improve your quality of life. From conservative modalities to surgical inventions, there are various paths to explore with your spine surgeon. 

At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board certified, spine fellowship trained neurosurgeon who specializes in conservative management, second opinions, and minimally invasive spine surgery. Dr. Kalra is known for his bed side manner and has stated “One of the most important things we do at Karla Brain & Spine is to make sure our patients have all the information they need about their condition and treatment options so they can make an informed decision about their health care.” Dr. Kalra has been recognized as a D Best Neurosurgeon in Dallas by his physician colleagues from 2017-2023. If you have unanswered questions about your spinal stenosis, need a second opinion, or to obtain the neurosurgical treatment you need contact Kalra Brain & Spine at (972) 905-9226 or request an appointment on our website.   

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Understanding Your Spinal Anatomy

Understanding the anatomy of your spine’s structure will help to better comprehend radiculopathy and sciatica. Your spine works to support your body, allows you to be flexible and move, as well as protects your spinal cord and nerves. A healthy spine will have an S-shaped curve. Your neck and low back have soft forward curves, while your mid back and sacral spine have small backwards curves. These natural curves aid in movement and shock absorption. These curves and your spinal discs aid in distributing weight and forces evenly through your spine. If your spine was straight instead of an S-shape it would take tremendous wear and tear creating significant spinal disorders. These S-shapes allows a portion of the weight and forces to be distributed to your spinal discs, and not solely to the vertebrae below much like a spring. Overtime, this wear and tear with the aging process result in degeneration of these discs. 

What Structures Make Up Your Spine?

The structure of your spine consists of over one-hundred twenty (120) muscles, two-hundred twenty (220) ligaments, one-hundred joints (100), thirty-three (33) vertebrae. Your spine consists of many complex structures:

• Vertebrae are the small bones that are stacked or aligned to created your spinal canal. These thirty-three (33) bones protect the delicate structures of your spinal cord and nerves

• Intervertebral discs are the flat round cushions that sit between each vertebrae and act as shock absorbers. Each vertebral disc has a soft gel like center with a tougher but flexible outer ring. Under pressure or intense forces this inter gel like center can squeeze out through the outer ring of the disc causing a herniation. This disc material can thencompress your nerves or spinal cord resulting in sciatica or radiculopathy.  

• Spinal cord and nerves make up your spinal canal and run under the vertebrae from the base of your skull to your low back. Thirty-one (31) pairs of nerves branch off from your canal through small openings in the vertebrae. These nerves carry messages between your brain to your muscles. When disc material compress these nerve roots  you often end up with nerve pain referred to as radiculopathy. 

• Facet joints are the connections between each spine level. These are located on the posterior (backside) of the vertebral body and provide structural stability to the spine.   They also limit and guide the motion of each spinal level. These joints can be a significant source of pathology including arthropathy, infection, inflammation, tumors, and trauma. 

• Soft tissues are the non-bony and non-disc aspects of the spine that are primarily muscles, ligaments, and tendons. These muscles and ligaments provide stability, strength, and facilitate spinal movement. Injuries to soft tissues of the spine may be tears or sprains/strains such as whiplash. 

What Are the Different Segments of the Spine? 

The thirty-three (33) vertebrae and thirty-one (31) pairs of spinal nerves that comprise your spine are divided into five segments: 

• Cervical vertebrae are the first seven (7) vertebrae of your spine in your neck. These levels are identified as C1 being the first and highest neck bone through C-7 being the last (C1-C7). There are eight pairs of cervical nerve roots, with one member of the pair exiting on the right side your vertebrae, and the other on the left side. 

• Thoracic vertebrae are the vertebrae located in your upper-mid back. These twelve (12) vertebrae or levels start just below the last cervical vertebrae at T1, and continue down the spine to T12 (T1-T12). There are twelve (12) pairs of thoracic nerve roots that exit at each level, with one member of the pair exiting on the right side, and the other on the left. 

• Lumbar vertebrae are the vertebra located in your low back. These five (5) vertebrae start just below T12 at L1 and continue down your spine to the last lumbar vertebrae at L5 (L1-L5). There are also five (5) pairs of lumbar nerves that exit at each level, with one member of the pair exiting on the right side, and the other on the left. 

• Sacral vertebrae are the vertebrae that are located in your pelvis. These five (5) vertebrae start below L5 at S1 and continue down your spine to the last sacral vertebrae at S5 (S1-S5). There are also five (5) pairs of sacral nerves that exit at each level, with one member of the pair exiting on the right side, and the other on the left. 

• Coccyx vertebrae are four (4) small vertebra that are fused together to form your tailbone. There is only one (1) pair of coccygeal (Co1) nerves that meet in the area of the tailbone. 

What is Radiculopathy? 

Radiculopathy is a medical condition characterized by compression, irritation, or inflammation  of spinal nerve roots, this leads to pain, numbness, tingling, or weakness along the path of the affected nerve. This condition can occur in the cervical, thoracic, or lumbar regions. Radiculopathy most commonly occurs in the cervical and lumbar areas of the spine.

Common Causes

• Spinal stenosis

• Degenerative disc disease

• Bone spurs

• Spinal injury or trauma

• Herniated discs 

Symptoms and Presentation

Symptoms of radiculopathy vary depending on the location of the affected nerve root.

• Decreased sensation in the skin

• Numbness of tingling sensations

• Sharp burning pain that radiates along the nerve path

• Muscle weakness or loss of reflexes

Diagnosis and Treatment

To properly diagnose radiculopathy your physician will typically review your medical history, conduct a physical examination, and order imaging studies such as a x-ray, MRI, or possible nerve test called EMG. Fortunately, the majority of patients can obtain relief of their symptoms with conservative treatment modalities and time. Initial conservative modalities may include anti-inflammatories, physical therapy, and activity modifications such as avoiding activities that cause strain to the back or neck. If you do not respond to the initial course of conservative treatment a referral to pain management may be recommended to obtain an epidural steroid injection or nerve block. For most patients, this will help reduce inflammation and nerve irritation to lessen the symptoms of radiculopathy. You may need additional repeat injections if you did not achieve relief of your symptoms, or if the relief of your symptoms was not lasting. 

Unfortanently, some patients will exhaust conservative treatment modalities and not achieve symptom relief. In this situation your chronic nerve pain may be affecting or limiting your daily activities. This persistent discomfort can make routine tasks feel like monumental challenges. At this point surgical intervention such as a microdiscectomy or laminectomy may be appropriate to consider. A microdiscectomy is a minimally invasive surgery to remove the portion of herniated disc material. A laminectomy is performed by removing a portion or all of the lamina (vertebral bone). This helps create space to relieve pressure on your spinal cord or nerves. A proper diagnosis and early intervention can significantly improve your outcomes, hopefully allowing you to avoid a surgical procedure. 

Understanding Sciatica

Sciatica is a common condition that can cause significant pain and discomfort. It occurs when your sciatic nerve, the largest and longest nerve in your body becomes injured, irritated, or compressed. Your sciatic nerve is actually not one (1) nerve, it is a bundle of five (5) nerves that branch off from your spinal cord. Your sciatic nerve extends from your low back, through an opening (sciatic notch) deep in your buttock, crosses behind muscles located deep in your hip joint, descends down the back portion of the upper thigh, to the back of your knee. Here the nerve divides into two branches. One brach continues down the back of your calf to your heel and sole of your foot. The other branch runs along the outer part of the knee to the lower leg and foot. Your sciatic nerve has both sensory and motor fibers. These fibers provide not only sensation, but function to your lower limbs. 

Common Symptoms

The primary attribute of sciatica is a shooting pain that travels along the above path of the sciatic nerve and spreads down your buttock to the back of one thigh or from your buttock down to the bottom of your foot.  This compression leads to a distinct type of nerve pain that can vary from tolerable to severe. Some patients will describe their symptoms as a dull ache, while others will experience a sharp, burning sensation, numbness and tingling, or even weakness. 

Common Causes

Numerous factors can contribute to the development of sciatic:

• • Herniated discs occur when the soft inner portion of a spinal disc protrudes through the tougher outer shell, often times pressing on the nerve roots that exit the spine.

• • Spinal stenosis is a condition where the spinal canal narrows, which can also put pressure on surrounding nerves. 

• • Spondylolisthesis is when a vertebra moves or slips out of place compared to the subsequent adjacent vertebrae. 

• • Compression fractures occur when there is a fracture in a vertebra causing it to collapse.

• • Osteoarthritis or spinal arthritis occurs from wear and tear or degenerative changes in the spine.

• • Scoliosis is an abnormal sideways curvature of the spine. 

Risk Factors

Risk factors for developing radiculopathy include:

• • Aging

• • Being overweight

• • Poor posture

• • Improper lifting techniques

• • Repetitive motions

• • A family history of degenerative bone conditions

• • Smoking

Diagnosis and Treatment

Sciatica is typically diagnosed by reviewing your medical history and a physical exam. Your physician may ask various questions about the location of your pain and symptoms. Additional diagnostic studies such as x-rays, magnetic resonance imaging (MRIs), or elcectomygraphy (EMG), may be recommended.  Sciatica will usually heal on its own with time and conservative treatment. Sciatica often results from a spinal issue that puts pressure on the sciatic nerve. If your sciatica is caused by a lumbar disc herniation, spinal stenosis, degenerative disc disease, or spondylolisthesis your physician may recommend a surgical procedure. To help relive the pain, treatment often includes:

• • Heat or cold therapy

• • NSAIDs

• • Physical therapy

• • Epidural steroid injections

• • Nerve blocks 

• • Massage 

• • Microdiscectomy

• • Laminectomy 

Common Symptoms of Radiculopathy and Sciatica 

Pain Sensations and Pattern

The classic symptom of both radiculopathy and sciatica is radiating pain. This discomfort or nerve pain typically follows the path of the affected nerve, creating a distinct pain pattern known as a dermatome. With radiculopathy you may experience sharp, burning, or electric like pain that travels from your spine to your extremities. Sciatica specifically involves pain that radiates from your low back, down the back of your thigh or from your low back to the bottom of your foot. With this pain you may also be experiencing:

• • Muscle weakness or difficulty moving certain body parts

• • Numbness or tingling sensations in the affected area

• • Heightened sensitivity to touch

Location Specific Symptoms

The location of your symptoms provide valuable clues about which spinal nerves are being affected. When a spinal nerve is compressed, irritated, or injured it may be on the left, right, or both sides of your spine. All three locations will produce varying symptoms. 

• • Cervical radiculopathy involves pain, numbness, or weakness in your neck, shoulder, arm, or hand.

• • Thoracic radiculopathy involves discomfort in your upper abdomen or chest wall.

• • Lumbar radiculopathy (including sciatica) involves pain in lower back, buttock, leg, or foot. 

While radiculopathy and sciatica are often used interchangeably, radiculopathy and sciatica are not the same. Sciatica refers to symptoms caused by compression or irritation of the sciatic nerve, and is actually a type of lumbar radiculopathy. Remember all cases of sciatica are radiculopathy, but not all radiculopathy is sciatica. 

At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board certified, spine fellowship trained neurosurgeon who specializes in conservative management, second opinions, and minimally invasive spine surgery. Dr. Kalra is known for his bed side manner and has stated “One of the most important things we do at Karla Brain & Spine is to make sure our patients have all the information they need about their condition and treatment options so they can make an informed decision about their health care.” Dr. Kalra has been recognized as a D Best Neurosurgeon in Dallas by his physicians colleagues from 2017-2023. If you have unanswered questions about your arm or leg pain, need a second opinion, or to obtain the neurosurgical treatment you need call Kalra Brain & Spine at (972) 905-9226 or request an appointment on our website.   

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