Neurogenic claudication (nerve compression) due to lumbar spinal stenosis will commonly result in low back pain, pain in the legs and feet, and impaired mobility, particularly in more elderly patients. This type of symptomatic spinal stenosis is the single most cited reason for spinal surgery in patients over sixty-five years old but not all types of spinal stenosis require back surgery.
If you have back pain make sure you know the cause as it could be that your fear of back surgery is unnecessary and other types of back pain relief are preferable.
Causes of Back Pain
When diagnosing spinal stenosis, physicians will usually make use of radiography and physical examination to determine the extent and type of spinal stenosis causing symptoms. The location of the spinal narrowing can also vary, resulting in varied symptoms and, potentially, different treatment options. Central canal stenosis can cause both spinal cord and spinal nerve root compression whereas facet joint stenosis (subarticular stenosis) is more likely to produce nerve compression alone, as is neural foraminal stenosis.
Congenital Spinal Stenosis
Symptoms of pinched nerves in the back may be caused by congenitally short pedicles that mean that minor degenerative changes in the spine are less well tolerated and result more quickly in symptoms than in patients with longer pedicles. These symptoms of congenital spinal stenosis will usually arise when a patient is in their twenties, thirties, forties, or later in life, and are not usually a problem in youth as the spine remains strong, supple, and free from degeneration.
Degenerative Spinal Stenosis
Age is a key factor in the most common type of spinal stenosis – acquired degenerative stenosis. This involves degeneration of the discs in the spine as well as the facet joints and also often the ligaments and muscles of the back. As the process of disc degeneration leads to loss of disc height, bulging discs, and even disc rupture or herniation the ligamentum flavum may begin to fold into the spinal canal causing spinal stenosis and symptoms of neurogenic claudication.
Facet Joint Disease and Spinal Stenosis
Facet joint osteoarthritis is also age-related in most cases and may result in the growth of bone spurs (osteophytes) which further reduce space in the spinal column and cause pinched nerves. This process is commonly triggered by the spine itself in an attempt to restore lost stability by enlarging the joints and creating a wider surface area for contact between joints as the discs degenerate. These thickened joint capsules can then produce spinal cysts which, in turn, can reduce space for nerve roots and create spinal stenosis symptoms such as low back pain, sciatica, and reduced walking distance.
Spondylolisthesis and Spinal Stenosis
Specific spine conditions such as degenerative spondylolisthesis will usually cause back pain as the major symptom, with neurogenic claudication a secondary issue that may have less impact on a patient’s quality of life. Spondylolisthesis may also arise after a spondylolysis (slippage of the spine) through trauma to the pars interarticularis, for example.
Spinal Stenosis Caused by Back Surgery
Back surgery itself can result in a type of spinal stenosis, especially where spinal fusion occurs and adjacent segment syndrome arises. The cause of this is the redistribution of pressure and weight-bearing responsibility on the vertebral levels either side of the fused section of the spine and so degeneration may happen more quickly in such segments.
Other Causes of Spinal Stenosis
Sometimes the cause of spinal stenosis is not due to degeneration of spinal tissues per se but is connected instead to a chronic state of inflammation, an excess of corticosteroids (as can occur in Cushing’s disease), as well as Paget’s disease, acromegaly, and other conditions that may also cause symptoms unrelated to the spine. Such conditions can create confusion around diagnosis as patients, and their physicians, do not connect the myriad symptoms arising from a systemic illness. Treating the back pain palliatively is unlikely to prove effective and it is, instead, the goal of therapy to treat the underlying illness to provide back pain relief and relief from other symptoms.
Diagnosing Spinal Stenosis Types
Noting when back pain first started, the nature and progression of symptoms of neurogenic claudication, and the presence of other health concerns can all make it easier to determine the type of spinal stenosis causing the problems. Congenital spinal stenosis, or specific spinal trauma in youth will likely be the cause of back pain in those aged twenty to forty, while spondylolytic changes in the spine are often a cause of back pain in teens and young adults.
How Age Affects Types of Spinal Stenosis
Older patients may be suffering from early symptoms of degenerative disc disease or degeneration of other spinal tissues or may have an autoimmune disease that could have been triggered around the hormonal upheaval of pregnancy or menopause. Degenerative spinal stenosis is the usual culprit for patients over sixty years old but many people reach this age without back pain and remain asymptomatic even when imaging shows signs of spinal stenosis. Back surgery at any point in life can lead to iatrogenic spinal stenosis, particularly post-laminectomy, or post-fusion. There are numerous classifications of spinal stenosis, with many causes and myriad symptoms; all warrant specific treatment so working out which type of spinal stenosis you have is key to finding back pain relief.