Stenosis from spurs
If these calcium deposits, called "spurs," become large enough, they occupy space inside the spinal canal or nerve openings and push against the nerves or against the spinal cord. When the spurs push on the nerves or spinal cord, they interfere with proper functioning of the nervous system. Pain, numbness, or weakness can result.

Stenosis from discs
Other ways spinal stenosis can develop involve theintervertebral discs. An intervertebral disc sits between every two bones of the spinal column, and cushions the movement of the spine. An intervertebral disc can herniate and press on a nerve, causing severe pain which runs down the arm or leg.

For information concerning herniated discs, please ask for our other informational brochures, "Cervical Spinal Surgery" and "Microsurgical Discectomy."

An intervertebral disc can degenerate slowly and cause spinal stenosis
As the disc breaks down, it can bulge backward into the spinal canal and into the nerve openings at the side of the spinal column. If there is already restriction of the nerves or spinal cord by bone spurs, then the additional pressure from the bulging disc can cause a problem with the functioning of the nervous system.

A disc can be absorbed by the body
A disc problem can also caus spinal stenosis in another way. If an intervertebral disc degenerates and dries up,the bones of the spinal column sink down and become closer together. This partially closes off the openings in the sides of the spine and can pinch the spinal nerveswhich travel through those openings. This is called "Disc Resorption Syndrome,"because part of the intervertebral disc is absorbed by the body and space is lostinside the spinal canal and nerve channels.

If the disc degenerates and collapses, the vertebrae squeeze together. This narrows the nerve channel, and the nerve root may get pinched, causing pain, numbness, or weakness. This is one form of "spinal stenosis."

Symptoms of spinal stenosis
Spinal stenosis can cause pain in several ways. The pain can occur from painful muscle spasm as the body tries to limit motion at the affected segment. It can occur from painful inflammation in the ligaments around the involved segment.

The pain can also occur from direct nerve irritation by the bone spurs or protruding intervertebral disc. The bone spurs or discs rub against the nerves, especially when the person stands or moves.

Sometimes pain occurs in the legs during walking because the tight spinal canal is cutting off the circulation to the nerves inside the spine. When muscles work, the nerves to those muscles also work, and require more blood to nourish them. If the nerves don't get enough blood, then pain develops and is felt either in the back or in the legs.

Sometimes spinal stenosis can cause serious weakness without causing pain. Pressure on the nerves can cause weakness in the muscles supplied by those nerves, without necessarily causing pain. For example, the legs may feel as if they are going to give away when the person walks or climbs stairs. In the neck, bone spurs or protruding discs can cause pressure on the spina cord, with or without pain. This may result in progressive problems with walking and a lack of coordination in the arms and legs.

The treatment of spinal stenosis
The treatment of spinal stenosis depends on where the pain is coming from. If the pain is due to painful muscle spasm or misalignment of the facet joints, then chiropractic and physical therapy may relieve the symptoms.

If weak abdominal muscles and pelvic muscles are providing poor spinal support, then excessive spinal motion may result in increased nerve irritation from the spinal stenosis. A program of muscular conditioning by a chiropractor or physical therapist may help the symptoms. The temporary use of a lumbosacral corset or back brace may also help relieve the symptoms while muscle strength is being restored.

If direct pressure on the nerves is resulting in pain or weakness of the legs or arms, then traction may help. Sometimes medication can relieve the pain, such as anti-inflammatory medication or non-narcotic analgesics ("pain killers").

Narcotics, such as synthetic codeine preparations, should be avoided. Because the symptoms of spinal stenosis may persist for a while, there is a tendency to become addicted if narcotic medication is used.

Sometimes a cortisone-type of medication can be placed directly inside the spinal canal or nerve channel. This is called an "epidural injection," and soothes the nerves by relieving inflammation.

Injections to lessen chronic inflammation may also help if the pain is coming from painful ligaments around the facet joints or the sacroiliac joints.

If the person smokes, it is very important to stop. Smoking constricts blood vessels and deprives the nerves of the circulation they desparately need. Smoking keeps tissues from healing by depriving them of oxygen and other nutrients which they need to heal. If pain or weakness is severe or is gradually worsening in spite of conservative treatment, then surgery may be recommended.

Surgery for spinal stenosis
Surgery can help by enlarging the openings in the spine and creating more room for the spinal cord and nerves. If the stenosis involves the low back, the surgery is called a "decompressive laminectomy." The term "laminectomy" simply means that part of the bone over the back part of the spinal column is surgically opened. This allows the surgeon to remove the spurs that are pinching the nerves. If a protruding disc is also pinching the nerves, then a portion of it may have to be removed as well. The goal of lumbar surgery for spinal stenosis is to remove enough bone to relieve the stenosis, but not enough bone to cause instability. If the spine becomes unstable, a fusion is required. Sometimes the stenosis is so extensive that a lot of bone removal is required and instability can't be avoided. In these cases, a fusion is usually done, either as part of the decompressive operation or later as a second operation.

	If the stenosis involves the cervica spine in the neck, then the spurs may be pressing on the spinal cord as well as the nerves to the arms. Often the surgeon will approach the problem from the front and perform "Anterior Cervical Surgery." He or she removes the portion of the spinal column in front of the spinal cord to open the spinal canal from that direction.
Usually a fusion is performed to stablilize the spine when cervical surgery is performed from the front. This is called an "interbody fusion," because the fusion bone runs between the vertebral bodies.

Postoperative care
After surgery, you will start a simple exercise program. Approximately one week after surgery, you should start working again with your chiropractor or physical therapist for training in exercises, general conditioning, and spinal stabilization If you have had cervical spinal surgery, you will probably need to wear a neck brace for a few weeks.

Your general conditioning program should start within a week after the procedure. You should begin by walking 20 to 30 minutes per day. You should gradually increase the pace of your walking as you feel stronger. If you like to swim and have access to a swimming pool, swimming is a very good form of exercises for people who have had low back surgery. It’s often a good idea to use a mask and snorkel, so you don’t have to move your neck or low back too much. You should wait 3 to 4 months before doing more active sports, such as tennis, running, or skiing. If things go as they usually do, you should be able to go back to work 4 to 6 weeks after the surgery, provided you do not have a job which requires heavy physical work. If you have that sort of job, then you may have wait 3 to 4 months before you go back to work.