Spinal Canal Stenosis

What is spinal canal stenosis?
Spinal canal stenosis is caused by the narrowing of the spinal canal. Normally, there is enough room in the spinal canal for the spinal cord to travel freely; however, when there is narrowing of the canal, there may be some compression of the spinal cord and or the exiting nerve roots. Most commonly, this is caused by degeneration or osteoarthritis of the spine where there is increased bony growth or changes in alignment of the vertebrae, thickening of ligaments within the spinal column or bulging of the discs.

Occasionally, the narrowing can be due to trauma of the spine.
Canal stenosis most commonly occurs in the lumbar spine (lower back) or the cervical spine (neck).



What are the symptoms of canal stenosis?
Narrowing of the spinal column can place pressure on the spinal cord and/or the exiting nerve roots causing neurological symptoms in the legs or arms. This may include pins and needles, decreased sensation, burning or weakness.

In the cervical spine, this is often aggravated by flexing the neck forwards or holding the head in extension for long periods such as lifting the head up when riding a bike. In the lower limbs it’s often aggravated by standing, walking or arching the lower back, with symptoms being relieved by bending forwards or flexing the lumbar spine.

Other symptoms may include aching in the lower limbs which is worse with prolonged standing and walking. This is known as neurogenic claudication. Again, it is usually relieved by sitting and resting or bending forwards.

Occasionally, if there is a lot of pressure on lower part of the spinal cord (cauda equina) there can be decreased sensation around the buttocks and perineum and loss of control of the bladder or bowel. This is rare, but requires immediate medical attention.

Who does spinal canal stenosis effect?
Because canal stenosis is commonly caused by degenerative changes, it often affects people over the age of 50. It can also affect those with conditions that alter the shape of the spine such as osteoarthritis, rheumatoid arthritis, spondylosing arthropathy, or previous injury, surgery or trauma to the spine.

How is it diagnosed?
Spinal canal stenosis is diagnosed with a combination of a clinical assessment as well as medical imaging. Imaging usually includes an MRI which will give a clear picture of the bony on the soft tissue structures of the spine. An x-ray or CT scan is sometimes included in the images requested.

How is it treated?
Treatment most commonly includes a combination of conservative interventions. Physiotherapy may include manual therapy to help to improve the movement of the spine. Stretches can also help to improve range of motion and relieve symptoms. Strengthening exercises for the spinal muscles often help to improve posture and alignment of the lumbar or cervical spine and take pressure off the neural structures. Strengthening of the lower limb muscles can also help to improve function if weakness is present.

Pain relief and anti-inflammatory medications can be prescribed by your GP to help relieve symptoms and decrease inflammation. Occasionally, corticosteroid injections are used and rarely, if symptoms are severe and persistent, surgery is sought.