Back pain, neck pain, and radicular pain may be connected to bone spurs and spinal stenosis as these bony growths (osteophytes) can cause compression of nerves and blood vessels in the spine and alter mobility. In some cases the bone spurs may grow as part of an effort by the body to actually relieve back pain and provide stability to the spine should it have become compromised. In conditions such as plantar fasciitis, for example, where ligaments and tendons rub against the bones in the spine causing damage, the body may respond by creating new bone to repair the damage and this can lead to deformity and osteophyte growth. Rheumatoid arthritis can also result in the growth of bone spurs and spinal stenosis development due to abnormal cell division and hypertrophy. There are numerous other conditions which commonly lead to spinal stenosis due to bone spurs rather than necessarily through spinal slippage, degenerative disc disease, or acute trauma, although these are, to some extent, interrelated.
Causes of Bone Spurs and Spinal Stenosis
Where the balance of the spine is upset, be it through a congenital abnormality, injury, or chronic wear and tear, the body will try to bring about stability by creating wider flat surfaces at the edges of the bones to control movement. This can actually be advantageous and could relieve back pain in some people where spinal stability is increased and cartilage degeneration is slowed after bone spur growth. However, in this process the resulting bone growth can narrow the spinal canal, particularly in areas at the edges of the facet joints and in the foramen where the nerve roots exit the spine. If the patient already has narrow foramen or any degree of disc bulging or disc herniation then this osteophyte growth is more likely to create symptomatic spinal stenosis as the nerve roots become compressed causing conditions such as a pinched nerve in the neck.
Diagnosing Bone Spurs and Spinal Stenosis
Some patients with spinal stenosis will, however, have evidence of a number of bone spurs causing nerve compression, impingement of the intervertebral discs, and even spinal cord compression. It is important that the physician correctly isolates the true cause of the symptoms of spinal stenosis as the number one cause of failed back surgery syndrome is a wrong diagnosis which can lead to the removal of material unrelated to the pain, leaving the troublesome area unaddressed. Selective nerve root blocks can be helpful in determining the extent to which individual spinal nerves are contributing to back pain following examination of X-Rays and MRI scans which can reveal bone spurs and spinal stenosis.
Symptoms of Bone Spurs and Spinal Stenosis
Ligaments and spinal muscles may also be impacted if bony growth occurs on the outer edges of the vertebrae and facet joints and circulation may be compromised if blood vessels become pinched by these bone spurs. Ischaemia, muscle spasm, pain in the back muscles, and, eventually, weakness and muscle atrophy may occur if nerve innervation and blood supply to the spinal muscles is chronically compromised by spinal stenosis from bone spurs. A pinched nerve due to bone spurs and spinal stenosis might also cause pain, numbness, weakness, or a sensation of pins and needles in the arm, hand, shoulder, face, legs, or feet along with back and neck pain in some cases. Patients may not, therefore, initially associate their symptoms with a back problem which is why it is important to let a physician know all new symptom development whether it seems unrelated or not. Even alterations in sleep and energy patterns, dizziness, gastrointestinal issues, and memory problems, can be due to spinal stenosis as nerves and blood vessels involved in the function of the thyroid gland, oesophagus, digestive sphincters, and other tissues and organs can be adversely affected.
Treating Bone Spurs and Spinal Stenosis
Bone spurs and spinal stenosis represent a mechanical problem rather than an inflammatory one, although the physical obstruction of osteophytes can create inflammation in other tissues if they are damaged by the bone spurs. The use of NSAIDs is, therefore, unlikely to offer any significant degree of relief from back pain, neck pain, sciatica, or radicular pain which is caused by bone spurs. Surgical removal of the bone spurs is the usual form of treatment where spinal stenosis symptoms are not able to be managed with conservative treatments. The type of back surgery undertaken is dependent on the extent of bone spurs and spinal stenosis and the location of these. Where a single foramen contains a bone spur that is responsible for nerve compression and pain a microforaminotomy may be appropriate and is a minimally invasive surgical procedure that allows a prompt recovery by most patients and avoids many of the risks of more invasive surgery.
Traditional open back surgery, such as a laminectomy with fusion, may be indicated for patients with widespread spinal stenosis as this can allow better access for the surgeon to remove bone spurs and then stabilize the spine. On occasion the bone spurs may actually dislodge from the bone and cause obstruction of synovial fluid in the facet joints or restrict mobility as they lodge in between other bones in the spine. These are usually visible on diagnostic scans and can then be removed during back surgery. Bone spurs and spinal stenosis co-exist with other spinal problems and this can make it hard for surgeons to assess the relative contribution of each condition to a patient’s symptoms.
Who is at Risk of Bone Spurs and Spinal Stenosis?
Bone spurs may remain ‘silent’ for many years making it difficult to determine cause and effect in a number of cases. A cascade of problems can often result from a single acute injury such as whiplash where the neck’s connective tissue may become dysfunctional leading to cervical spinal instability which, in turn, causes bone spurs to grow to try to stabilize the spine but which can inadvertently cause further cartilage degeneration. Abnormal bony growths can also occur in the ligaments of the spine which can cause stiffness and inflexibility. Those with physically demanding jobs, such as construction workers, gymnasts, fighter pilots, professional golfers, and even surfers carrying heavy boards on their neck and shoulders, are at increased risk of bone spurs and spinal stenosis as wear and tear are more likely to occur in such jobs. Bone spurs and spinal stenosis are quite common but it is the degree of growth and narrowing that determines the extent of back pain.