Do you feel weak or numb in one or multiple limbs? Does this feeling seem to come and go, and is it sometimes accompanied by back pain? Have you noticed that you’ve had to change the way you walk or that your foot doesn’t seem to obey your commands anymore wholly? Then you may be struggling with a condition called spinal stenosis.
Spinal stenosis can occur naturally and slowly. Its most significant risk factor is simply aging. As we get older, a growing list of complications can cause the canals within our spinal bones to narrow, compressing nerve roots and the spinal cord itself and causing a host of symptoms associated with nerve compression.
A Primer on Spinal Stenosis
Spinal stenosis occurs when the foramen of a vertebra closes around the spinal cord’s nerve roots or when the spinal canal itself compresses the spinal cord. Any level of narrowing and subsequent compression can be called spinal stenosis, which is why there is a varying degree of severity between different cases.
Certain conditions are specifically linked to spinal stenosis in that they cause a narrowing of the space in and around the spine. These include certain extreme curvatures of the spine, such as scoliosis, spondylolisthesis (which occurs when a vertebra slips out of place), and spondylitis (inflammation in the spine).
The signs of spinal stenosis may often be conflated with other spinal conditions, which is why even if you suspect that spinal stenosis matches your symptoms, it’s important to get an accurate diagnosis from a medical professional utilizing imaging tests such as MRIs and x-rays to analyze your spine and surrounding soft tissues.
Spinal Stenosis Red Flags That Require Immediate Attention
Before we get into the telltale signs of spinal stenosis, it’s important to know what symptoms require your immediate attention. These symptoms are signs of severe stenosis that may have lasting long-term consequences, including paralysis and worse.
- Loss of bowel control
- Numbness in the genitals/inner thigh
- Extreme weakness in both legs (cannot walk/barely move)
Although many spinal stenosis cases begin with mild narrowing in the spine, a severe case can lead to permanent loss of feeling and mobility in the lower body and other similar consequences. If you are experiencing any of the above, call a doctor immediately.
Telltale Signs of Spinal Stenosis
When bony tissue closes around the spine’s nerves, different things might happen depending on what nerves are affected. The most common signs of spinal stenosis include:
1. Pain and Numbness in the Lower Legs
Neurogenic claudication, or lower leg cramps and pain associated with nerve damage, is a common symptom in spinal stenosis cases. Signs of neurogenic claudication include:
- Increased pain when taking long strides.
- Increased pain when bending backward.
- Reduced pain with rest/while laying down.
- Increased pain when performing activities while upright.
- Struggling with consistent pain and numbness while standing.
While struggling with neurogenic claudication, other relief sources include bending forward or flexing the spine (such as while squatting, curling up, sitting forward, or leaning on a cart or walker). Cramps can also cause claudication as a result of vascular issues, such as diabetes. A differential diagnosis is important to determine whether spinal stenosis is the main cause of the pain.
2. Radiating Pain Through One Side
When the pain is mostly present or entirely present in one side, particularly running through the buttock, thigh, and calf, then the cause may be sciatica, which can be a symptom of spinal stenosis. Sciatica is a condition caused by the compression of the sciatic nerve, the largest nerve in the human body, and the one most likely to be affected by spinal injuries due to its origin in the lumbar region (lower back), the most vulnerable part of the spine. When the sciatic nerve is compressed at any point (usually either at the buttock or near one of its nerve roots in the lower spine), the pain it causes radiates down one side of the body, sometimes down to the toes.
3. Sudden Gait Changes
Because spinal stenosis often affects nerve roots connected to the legs, it can result in gait changes, sometimes almost imperceptible, until the problem becomes more severe. These may include difficulty maintaining balance, weakness in one or more thighs, foot drop (wherein the foot seems to limp and drag behind, and the patient struggles to raise their toes), and other problems related to numbness, weakness, or pain in one or more legs. Any issues related to gait are most likely linked to spinal stenosis in the lumbar or cervical (neck) region.
4. Foot Drop
Weakness in the foot, including foot drag, tripping more often, struggling to pull the toes up, and struggling to tiptoe, can occur due to the compression of one or more nerves throughout the lower region of the spine, including the lumbar vertebrae and sacrum (near the base of the spine). Again, there are many reasons why a nerve may be compressed or pinched near the spine. While a narrowing of the spine is one potential reason, other common reasons include bone spurs, herniated or swollen discs between the vertebrae, pre-existing spine curvature issues, and more.
5. Weakness in the Arms and Hand
Cervical spinal stenosis can lead to pain and weakness in the upper arm, neck, and shoulder. This may be felt on one or both sides and may be accompanied by numbness, tingling sensations, or a crawling sensation.
6. Losing Your Fine Motor Skills
Struggling to write, tie shoes, and button or unbutton clothes may sign spinal stenosis, especially when accompanied by recurring or constant tingling sensations in the hands and arms, numbness or pain in the neck and shoulders, and even balance issues.
How Spinal Stenosis Is Treated
When a case of spinal stenosis isn’t severe, treatment options may vary from pain management and physical therapy to addressing daily and work-related activities to reduce the risk of worsening symptoms. More severe cases, however, may require minimally invasive interventions, from epidural injections to nerve blocks. Surgery is very rarely advised or needed and only recommended in cases where significant neurologic deficits or immediate attention are required to save function in the limbs when more conservative options are no longer viable.