How Spinal Stenosis Is Diagnosed and Treated

How Spinal Stenosis Is Diagnosed and Treated

Spinal stenosis is a condition characterized by pressure on the spinal cord or the nerves that run from the cord to the muscles. Although spinal stenosis can occur in any part of the spine, it is most common in the lower back. This narrowing of the spinal canal may result from degenerative changes, herniated discs, ligament hypertrophy, or spondylolisthesis. This condition often results in numbness, pain, and/or weakness in the legs.

Understanding how spinal stenosis is diagnosed is crucial for receiving effective treatment. This blog post will explore the current diagnostic approaches and imaging techniques used to diagnose spinal stenosis, as well as common questions and concerns related to the condition. Timely diagnosis allows for early intervention and may prevent progression of neurological symptoms.

What Does Spinal Stenosis Leg Pain Feel Like?

During a physical examination, patients often experience leg pain associated with spinal stenosis. The degree of leg pain will vary from person to person. Typically, patients may feel cramping, burning sensations, and a deep ache. Meanwhile, some individuals may experience a radiating shooting pain down the legs during long periods of standing or walking. Typically, this discomfort improves after sitting down or resting. This presentation is consistent with neurogenic claudication, a hallmark of lumbar spinal stenosis.

What Are the Symptoms of a Spinal Stenosis Flare-Up?

Symptoms of a flare-up of spinal stenosis may include numbness in the legs, tingling, and increased pain. In addition, patients commonly report a significant decrease in their ability to stand or walk comfortably.
Additional symptoms may include:

• Difficulty with balance
• Leg weakness
• Increased lower back pain
• Leg cramps

What Are the 4 Stages of Spinal Stenosis?

An MRI imaging test can help determine the severity of a patient’s condition. Once your doctor has your MRI results, they can determine the severity of your spinal stenosis. While not universally adopted, this staging framework helps categorize the degree of canal narrowing and potential nerve involvement.

• Stage 0: No narrowing of the spinal cord
• Stage I: Mild stenosis
• Stage II: Moderate stenosis
• Stage III: Severe stenosis

The final stages of spinal stenosis may include the following symptoms:

• Leg pain with movement
• Trouble walking or standing
• Loss of bowel or bladder control: Loss of bowel or bladder control may indicate cauda equina syndrome and requires urgent surgical evaluation.
• Numbness in the feet, legs, groin, or upper thigh area

How Is Spinal Stenosis Diagnosed?

To diagnose lumbar spinal stenosis, your healthcare provider will conduct a complete physical examination and ask questions about your symptoms. During the physical exam, your provider will look for specific signs of spinal stenosis, such as weakness, abnormal reflexes, and loss of sensation. The diagnostic process may include the following:

• Physical exam: Your doctor will review your complete medical history, including asking about your back pain and how long the symptoms have lasted. Your range of spinal motion, coordination, and balance will also be tested.
• X-ray imaging: X-rays help identify bony abnormalities such as osteophytes, degenerative disc disease, or spondylolisthesis, but cannot evaluate soft tissues or canal narrowing well.
• Magnetic resonance imaging (MRI): MRI is the most sensitive modality for visualizing spinal canal narrowing, nerve root impingement, and disc pathology.
• Computerized axial tomography (CT scans): CT scans provide excellent bone detail and may be paired with a myelogram to assess nerve root compression in patients unable to undergo MRI.
• Myelogram: A radiologist injects liquid dye into the spinal column to show if a patient has pressure on the spinal cord or other issues, like a herniated disc.
• Lab tests: Lab work may be ordered to rule out infection, inflammatory disease, or malignancy in the differential diagnosis.

What Is the Gold Standard for Diagnosing Spinal Stenosis?

An MRI is commonly considered the gold standard for correctly diagnosing spinal stenosis. The image provides details of the patient’s spinal soft tissues, including discs and nerves, which assists your healthcare provider in properly evaluating the degree of spinal narrowing and identifying other associated issues, like a herniated disc. MRI can also assess for ligamentum flavum hypertrophy, synovial cysts, and foraminal narrowing.

What Is the Best Thing to Do for Spinal Stenosis?

The decision to proceed with surgery depends on the severity of symptoms, imaging findings, and response to conservative management. Some patients with milder spinal stenosis symptoms will successfully respond to more conservative therapies and non-surgical spine treatments, like physical therapy, medications, and lifestyle modifications. Meanwhile, patients with more severe spinal cord compression would explore surgical options, including open spinal stenosis surgery or minimally invasive spinal stenosis surgery. These surgical treatment options remove compression of the spinal cord and lead to overall improvement in the patient’s ability to function. Non-surgical spinal stenosis treatment options are a reasonable initial approach to treating spinal stenosis,

Non-surgical spinal stenosis treatment relieves pain and restores function, but it does not improve the narrowing of the spinal canal, although the associated symptoms can be improved. Non-surgical therapies for spinal stenosis include physical therapy, epidural steroid injections, and anti-inflammatory medication. Patient education and home exercise programs are also important components of non-operative care.

What Can Worsen Spinal Stenosis?

A variety of factors can worsen the symptoms of spinal stenosis, such as:

• A sedentary lifestyle leading to muscle weakness
• Weight gain adding increased stress on the spine
• Heavy lifting or twisting motions
• Long periods of walking or standing
• Degenerative progression over time may also worsen canal narrowing.

What Kind of Doctor Is Best for Spinal Stenosis?

To effectively diagnose spinal stenosis, board-certified neurosurgeons or orthopedic spine surgeons are best equipped to diagnose and manage spinal stenosis, including surgical and non-surgical treatments.

Conclusion

To properly diagnose spinal stenosis, a discussion of medical history, advanced imaging techniques and a physical exam are needed. If you or a loved one suspect you have spinal stenosis, consult with a qualified healthcare professional to review your symptoms and explore appropriate diagnostic approaches.

Diagnosing Spinal Stenosis in New Jersey

When in need of a spinal stenosis diagnosis, a patient’s choice of where to go is a significant decision. The experienced and innovative physicians at New Jersey Brain and Spine have helped patients for more than 25 years. We have treated more than 40,000 patients with complex spine conditions. We offer state-of-the-art diagnostics and individualized treatment plans for spinal stenosis.

Our spine specialists are available for comprehensive evaluation and second-opinion consultations. Please contact us today to discuss your diagnostic and imaging technique options or to seek a second opinion on your medical diagnosis.