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Everyone experiences back pain at least once. There are many situations that can trigger it—from lifting a heavy box to driving too long. Not all back pain, however, is created equal. Sometimes back pain results from the squeezing of the spinal cord or nerves that come off the spinal cord, a condition called spinal stenosis. When that happens, the pain can travel to other parts of the body like the shoulders, arms, or legs. That’s not ordinary back pain, but a signal that treatment is required. Read on to learn more about the condition knows as spinal stenosis.
What is spinal stenosis?
Spinal stenosis is a compression of the spinal cord or the nerves that lead off of the spinal cord, called nerve roots. Symptoms can present as back pain or even pain, weakness, and numbness in the shoulders, arms, hands, buttocks, and legs. Symptoms and treatment depend on the type and location of the nerve compression as well as the underlying cause.
The spinal cord runs down a channel between the front and back of the spine. It is protected by fibrous ligaments, muscles, discs, and bones called the vertebrae. Between each vertebrae, a pair of nerves called nerve roots run out of the spinal cord through holes, called foramen—one at the front and one at the back of the spinal cord.. These nerves pass all sensations and instructions between the brain and that part of the body, like the shoulders, triceps, or legs.
Nerve compression can occur at any place in the spine, from the neck (cervical spine) to the chest (thoracic spine) to the abdomen and lower back (lumbar spine), though the condition is most common in the lower back and neck.
The spinal cord or nerve roots can be compressed. Spinal cord compression, called myelopathy, is a serious condition and requires immediate treatment to prevent permanent nerve damage and possible spinal cord injury. Nerve roots can be squeezed just as they exit the spinal cord (lateral stenosis) or as they exit the vertebra to the body through the foramen (foraminal stenosis).
Any number of causes can pinch the spinal cord or nerve roots:
- Disk damage or degeneration
- Bone spurs
- Vertebrae slipping out of place (spondylolisthesis)
- Swelling of the ligaments
- Blood vessel problems
- Facet joint enlargement
When a nerve is compressed at the spinal cord, the effects can radiate to the part of the body the nerve feeds, causing pain, tingling, numbness, and muscle weakness in that part of the body, a condition called radiculopathy.
The exact number of people who have spinal stenosis is uncertain. The best guess is that more than 200,000 people in the U.S. have spinal stenosis. Spinal disc degeneration is a normal aging phenomenon - by age 60, more than 90 percent of people will show some degree of disc degeneration. Therefore, many people will develop spinal stenosis if they live long enough.
How is spinal stenosis diagnosed?
Diagnosis is made based on taking a medical history, performing a physical, and imaging. Most patients will bring the problem to a family physician, but the final diagnosis will be made by an orthopedist, orthopedic spine specialist, or neurosurgeon.
The physician will look for symptoms that will not only help diagnose spinal stenosis but indicate which vertebrae have nerve compression. Symptoms will depend on what part of the spine has nerve compression and how the nerve is compressed.
Cervical spinal stenosis symptoms include neck pain and pain, numbness, or weakness in the shoulders, arms, or hands—a condition known as cervical radiculopathy.
If the cervical spinal cord is compressed (cervical myelopathy), symptoms may include the legs as well as the arms and shoulders, since symptoms can be described at or below the compression point. Cervical myelopathy is a serious condition characterized by
- Neck pain
- Neck stiffness
- Fine motor problems
- Balance problems
- Walking problems
- Bowel or bladder problems
- Numbness, weakness, or pain in the arms, shoulders, and even legs.
Lumbar (lower back) spinal stenosis symptoms include:
- Lower back pain
- Pain or cramping in the buttocks or back of the thigh when standing or walking (claudication)
- Pain, numbness, weakness, or tingling in the buttocks and legs (sciatica).
In lumbar spinal stenosis, nerve compression typically resolves if a person leans forward or sits. A dramatic positional change in symptoms is often a clear sign of lumbar stenosis.
In a physical examination, the doctor will examine the spine for any problems. The doctor will observe the spine’s range of movement and flexibility as well as how the patient walks and balances. Muscle strength and reflexes will also be examined.
The final diagnosis will be made by imaging the spine, either with X-rays, a CT scan, or an MRI scan to identify exactly where the nerve compression is occurring. If the doctor suspects myelopathy or more serious nerve compression, tests such as a nerve conduction study or electromyogram can help determine the extent of nerve function loss.
Spinal Stenosis treatment options
Healthcare providers usually opt for conservative, non-surgical treatments to initially manage spinal stenosis. These include over-the-counter pain medications, physical therapy, bracing, and rest. Myelopathy is a more serious condition, as is spinal stenosis causing serious loss of nerve function. These and other serious cases may need to be treated with surgery.
Medications
Pain is treated initially with over-the-counter pain relief medications. In more severe cases, prescription pain medications such as prescription NSAIDs (nonsteroidal anti-inflammatory drugs), neuropathic agents, and opioids may be used for a limited time. When pain relievers don’t work, a steroid injection into the area may help relieve symptoms for up to several months.
Physical therapy
Physical therapy can help stabilize the spine, strengthen the muscles, and help people develop postural awareness to minimize the pain and symptoms of spinal stenosis. Physical therapy can include massage, icing, and heating pads, but the foundation of spinal stenosis physical therapy is stretching and exercise. A physical therapist will develop a daily stretching and exercise routine that over time can improve spinal alignment, flexibility, and coordination as well as strengthen the muscles that stabilize the spine.
Bracing
Low back braces are used to manage lumbar spinal stenosis in cases where physical therapy and pain relievers are not providing relief. Braces both relieve pressure on the spine, limit spine movement, and improve posture. They should only be used when prescribed by a doctor, are properly fitted, and worn correctly and consistently.
Surgery
When spinal stenosis is caused by pressure on the spinal cord (myelopathy) or involves debilitating pain or significant loss of nerve function, a neurosurgeon or orthopedic surgeon will perform surgical decompression, stabilization, or both.
Decompression surgery directly removes pressure from the nerve and can consist of:
- Removing the entire back area, or lamina, of an affected vertebra (laminectomy)
- Removing only that part of the lamina putting pressure on a nerve (laminotomy),
- Cutting and “hinging” the lamina to produce more room for the spinal cord (laminoplasty). This is only performed on vertebrae in the neck
- Removing the front of the vertebra (corpectomy)
- Making wider the opening (foramen) through which the nerve exits the vertebra (foraminotomy)
- Implanting structural devices in the spine to separate and properly align vertebrae (indirect decompression)
Stabilization is achieved through spinal fusion and is usually required with a laminectomy. Vertebrae are mechanically joined together with rods or hooks and a bone graft inserted between them. Eventually, the bone graft will fuse with both vertebrae, both stabilizing and immobilizing the spine at that place.
Emerging treatments
When spinal stenosis is due to intervertebral disk degeneration or ligament problems, some doctors are turning to regenerative therapies that kick-start the healing process in the damaged soft tissue. These include prolotherapy, in which healing is kick-started by injecting an irritant into the damaged tissue, platelet-rich plasma injection, or stem-cell therapy.
Alternative treatments
Many standard medical treatments for spinal stenosis are often ineffective, so patients understandably turn to alternative treatments. Some may achieve significant relief from pain, some may achieve nothing. Chiropractic treatment is often advised, but different chiropractors employ different techniques for spinal stenosis, so it’s hard to determine their effectiveness. The same applies to acupuncture and massage. There are no standardized acupuncture or massage techniques for treating spinal stenosis, so techniques and results can vary from one practitioner to another.
Spinal Stenosis medications
Most cases of spinal stenosis are treated conservatively with over-the-counter pain relievers, but more severe nerve compression and pain will be managed with prescription medications. Doses will be small and usually only be prescribed for a few days or weeks.
Analgesics
Most people with mild spinal stenosis can manage pain and swelling with over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, or naproxen) or acetaminophen. If these don’t work, the physician may turn to prescription NSAIDs such as diclofenac or celecoxib.
Neuropathic agents
Patients who are unable to take prescription NSAIDs or in whom NSAIDs are ineffective may be prescribed drugs that specifically treat nerve pain (neuropathy). Gabapentinoids such as gabapentin and Lyrica (pregabalin) were originally developed as anti-seizure (anticonvulsant) medications, but are now the neuropathic agent of choice to treat pain due to nerve compression.
Opioids
For moderate to severe nerve compression, the last line for pain management are opioids such as hydrocodone or oxycodone. Opioids are prescribed in the smallest dose possible to adequately control pain and for the shortest possible period of time.
Corticosteroids
As an alternative to pain medications, a physician may inject a corticosteroid such as methylprednisolone or betamethasone to the affected area to reduce soft tissue swelling causing nerve compression. Epidural steroid injections (ESI) can produce relief from pain for up to six months, but there are significant side effects.
What is the best medication for spinal stenosis?
Medications are only used to provide spinal stenosis symptom relief. They do not treat or cure the underlying condition. Some of these medications provide powerful pain relief but have serious side effects and may make the condition worse. For this reason, there is no “best” medication for spinal stenosis. Effectiveness will depend on the cause of the nerve compression, the responsiveness of the patient to medication, and tolerance for side effects.
| Best medications for spinal stenosis | |||||
|---|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects | |
| Aspirin | NSAID | Oral | One to two 325 mg capsules or tablets every four to six hours as needed | Upset stomach, heartburn, bleeding | |
| Motrin (ibuprofen) | NSAID | Oral | Two 200 mg tablets every four to six hours as needed | Nausea, bleeding, stomach pain | |
| Tylenol (acetaminophen) | Analgesic | Oral | One to two 325 mg tablets every four to six hours as needed | Nausea, stomach pain, loss of appetite | |
| Celebrex (celecoxib) | COX-2 Selective NSAID | Oral | One 200 mg capsule daily | Abdominal pain, diarrhea, stomach upset | |
| Voltaren (diclofenac) | Prescription NSAID | Oral | One 50 mg capsule three times daily | Abdominal pain, constipation, diarrhea | |
| Neurontin (gabapentin) | Gabapentinoid | Oral | One to three 100 mg capsules daily to three times daily; dose is titrated to effect | Dizzines, drowsiness, constipation | |
| Lyrica (pregabalin) | Gabapentinoid | Oral | Two 75 mg capsules taken twice a day; dose is titrated to effect | Weight gain, dizziness, drowsiness | |
| OxyContin (oxycodone) | Opioid | Oral | One 5 mg tablet every six hours as needed; lowest dose possible for the shortest duration possible | Constipation, nausea, drowsiness | |
| Depo-Medrol (methylprednisolone acetate) | Corticosteroid | Injection | 10 to 40 mg once | Mood changes, edema, increased blood pressure |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of spinal stenosis medication?
Pain relievers such as over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) and acetaminophen are widely available and safe. NSAIDs, unlike acetaminophen, interfere with blood clotting, so their most serious side effects are bleeding and bruising in general, as well as bleeding and pain in the digestive system. However, celecoxib is often prescribed because it does not affect the blood clotting pathway.
Gabapentinoids and opioids block pain signals by impacting nerve impulses in the brain and spinal cord. As a result, sleepiness, feeling tired, fatigue, dizziness, and fogginess are the most common side effects of these drugs. The most serious side effects of gabapentinoids and opioids are drug abuse and overdose. Gabapentinoids are less likely to produce dependence, but an overdose of either type of drug can be fatal.
Steroids can be highly effective at reducing spinal stenosis pain and other symptoms but they have several unpleasant and commonly-experienced side effects including mood and behavior changes, aggressiveness, increased appetite, weight gain, and high blood pressure. Although they provide significant pain relief, research suggests that they may make spinal stenosis worse over the long run and increase the risk of complications if surgery is required.
All medications may have side effects, and different classes of medications have different side effects. However, this is not a complete list, and you should consult with your healthcare professional for possible side effects and drug interactions based on your specific situation.
This is not a complete list of side effects. Consult with your healthcare professional for possible side effects and drug interactions based on your specific situation.
What is the best home remedy for spinal stenosis?
Spinal stenosis cannot be cured, but home remedies can help reduce pain and improve quality of life.
Rest
An integral part of spinal stenosis management is to rest periodically and avoid putting stress on the back or neck.
Exercise
Physical therapists have developed stretches and exercises specific to lumbar, cervical, or thoracic spinal stenosis that relieve pain, strengthen muscles, and stabilize the spine.
Lose excess weight
Excess weight puts stress on the spine. Losing the excess weight may not resolve the nerve compression, it will help to stabilize the spine.
Maintain good posture
Postural awareness is a critical component of spinal stenosis treatment. Bad posture puts abnormal stress on the spine and often causes nerve compression. A physical therapist will help you develop good posture to stabilize and strengthen the spine as well as reduce spinal stenosis pain.
Use over-the-counter pain relievers
For those times when the pain is a little bit too much, use over-the-counter pain relievers.
Frequently asked questions about spinal stenosis
What is the best treatment for spinal stenosis?
For most patients, spinal stenosis is treated conservatively with over-the-counter pain relievers, physical therapy, daily exercise, and rest. For severe cases of spinal cord compression, called myelopathy, surgery is the only option for preventing permanent and debilitating nerve damage.
What activities should be avoided with spinal stenosis?
Any activity that puts stress on the spine will not help spinal stenosis and may make the condition worse. This includes high-impact exercise, such as running, jogging, or contact sports, as well as heavy lifting.
How does spinal stenosis affect the body?
Spinal stenosis is a compression of the spinal cord or the nerve roots that run out of the spinal cord to the rest of the body. Each of these nerve roots controls a specific part of the body such as the shoulders, arms, chest, abdomen, and legs. Pinching the spinal cord or nerve roots can cause pain, tingling, numbness, and weakness in those areas of the body controlled by those nerve roots. The most serious consequence of spinal cord compression, called myelopathy, is spinal cord injury (SCI) which can result in permanent paralysis.
How do you prevent spinal stenosis from getting worse?
Exercise, stretching, and maintaining good posture are essential in preventing spinal stenosis from getting worse. It is also vitally important to avoid activities that put abnormal stress on the spine such as slouching, high-impact exercise, and heavy lifting.
How dangerous is spinal stenosis surgery?
All surgery is risky. Spinal stenosis surgery does carry a risk of worsening the symptoms, chronic pain, and nerve damage. Many spinal bone procedures, however, involve the use of ultrasonic cutting devices that can cut through bone but have no effect on soft tissues such as nerves or ligaments, reducing the dangers of spinal surgery. All told, spinal stenosis surgery doesn’t always succeed. A recent study found that about 29% to 42% of patients undergoing lumbar spinal stenosis surgery did not experience any change in symptoms.
How do you slow down spinal stenosis?
The progress of spinal stenosis can be slowed down with daily exercise, stretching, physical therapy, and rest. Most importantly, people should avoid putting abnormal stresses on the spine. Activities such as contact sports, running, jogging, and heavy lifting can make the condition worse. Bad posture is a major contributor to nerve compression in the spine, so maintain good posture at all times—sitting, standing, walking, lifting, and lying down.
Can you live a normal life with spinal stenosis?
Most people with spinal stenosis can live a normal life using conservative remedies such as over-the-counter pain relievers, stretching, exercise, physical therapy, rest, and avoiding activities and posture that puts abnormal stress on the spine.
Can you reverse spinal stenosis?
Spinal stenosis cannot be reversed or cured, but symptoms can be managed with pain relievers, exercise, stretching, and good posture. Severe myelopathy (compression of the spinal cord) will require surgery to prevent permanent nerve damage.
Is walking good for spinal stenosis?
Walking and swimming are excellent exercises for spinal stenosis. Both strengthen the muscles that help stabilize the spine. Make sure, however, that you maintain good posture when walking.
Related resources for spinal stenosis
- 5 Best Cervical Stenosis Exercises & Stretches
- Lower Back Pain Treatment and Medications
- Neuropathy Treatment and Medications
- Sciatica Treatment and Medications
- Spinal Stenosis
- Spinal Stenosis Stretches
- Top 5 Lumbar Spinal Stenosis Exercises & Stretches
- Ultrasound Techniques to Treat Spinal Stenosis
- When to Consider a Back Brace