Spinal Stenosis: Causes, Symptoms, and Treatment Options

If you’ve ever been told you have spinal stenosis, this article is for you.

I have a shorter video that briefly discusses this topic, which may provide enough of the information you’re hoping to learn, but I also wanted to provide a longer explanation with more figures and diagrams for those who want to understand it in greater detail.

Before you can fully understand spinal stenosis, let’s first understand normal spine anatomy.

Understanding Normal Spine Anatomy

The spine is made up of a series of bones called vertebrae, which stack on top of each other to form a protective column.

In your neck, called the cervical spine, and upper back, called the thoracic spine, your spinal cord travels through the center of this column. But in your lower back, or lumbar spine, the spinal cord ends and gives way to a bundle of nerve roots called the cauda equina, Latin for “horse’s tail” because of its appearance.

At each level of your spine, nerves branch off from the spinal cord or cauda equina and exit through small openings called foramina. These nerves then travel to different parts of your body, such as your arms, legs, or torso, carrying signals that control movement and sensation.

Between each vertebra sits a disc, which acts like a cushion or shock absorber. Each disc has a tough outer layer called the annulus fibrosus and a soft, gel-like center called the nucleus pulposus.

Behind the spinal column are the facet joints, which help you bend, twist, and move your spine. They’re like hinges that give your back flexibility while keeping it stable.

Understanding this anatomy is key to making sense of spinal stenosis because when any of these structures start to change or crowd the space around your nerves, symptoms can follow.

How Aging Changes the Spine

Aging isn’t just about wrinkles and gray hair. It happens deep inside our bodies, too, including our spines.

Just like skin loses elasticity, the spine goes through its own natural changes as the years go by.

The discs between the vertebrae can dry out, shrink in height, and start to bulge. Facet joints may enlarge, similar to how knuckles get bigger in people with hand arthritis.

Ligaments, which hold the spine together, can become weaker and cause some shifting of the spine. They can also thicken and stiffen.

All of these changes can crowd the space around the spinal cord and nerve roots, leading to narrowing. That’s what we call spinal stenosis.

How your spine ages depends on a variety of factors, including genetics, lifestyle, medical history, and exposure to things like nicotine, drugs, or certain medications.

When your MRI or CAT scan shows terms like degeneration, bulging, or narrowing, it doesn’t automatically mean something is wrong or that these findings are causing your symptoms.

A large study looked at over 3,000 people with no back pain at all. Even without symptoms:

• 80% of 50-year-olds had disc degeneration.
• 56% had lost some disc height.
• 60% had bulging discs.
• By age 70, 93% showed disc degeneration and nearly 70% had joint wear and tear.

The takeaway is that these changes are incredibly common. They’re part of the natural aging process, not necessarily a sign of disease or dysfunction.

What Does Spinal Stenosis Mean?

The word stenosis simply means narrowing. In the spine, that narrowing can happen in a few key places, including the central canal, where the spinal cord or cauda equina nerves travel, and the foramina, the small tunnels where nerves exit the spine and branch out to your legs, arms, or other areas.

But here’s the crucial thing to understand: Not all narrowing causes trouble.

Just because there’s stenosis doesn’t mean the spinal cord or nerves are being pinched or compressed. Many people have narrowing without any symptoms at all.

While the word stenosis might sound alarming, it’s not always a sign of danger.

When Does Spinal Narrowing Cause Symptoms?

Let’s break this down with a simple visual concept.

Imagine a circle representing the spinal canal of a healthy 20-year-old. Inside that circle are small dots representing the nerve roots traveling freely through the canal.

As we age, things begin to change. Discs may bulge, facet joints enlarge, and ligaments thicken. These changes gradually narrow the canal.

The circle gets smaller, but the nerves still have room to move. This is spinal stenosis, but at this stage, there’s no compression, no symptoms, and no need for treatment.

Now imagine that circle continues to shrink. The nerves begin to crowd each other and eventually may become compressed.

When that happens, stenosis can cause problems. Symptoms might include pain, numbness, tingling, or weakness in the arms or legs, depending on which nerves are affected.

In a lumbar spine MRI cross-section, you can see gray dots, the nerve roots, traveling through the central canal. As the narrowing progresses, the space around those nerves tightens.

But again, narrowing doesn’t always mean compression. Only when this space becomes critically tight do symptoms emerge.

Lumbar, Cervical, and Thoracic Spinal Stenosis

In the lumbar spine, stenosis affects the cauda equina, a bundle of nerve roots. In the cervical and thoracic spine, it can compress the spinal cord itself.

Let’s shift to the cervical spine.

Instead of scattered dots, imagine a solid circle representing the spinal cord. As the canal narrows, the cord may become compressed.

If severe, this can lead to numbness or tingling, weakness or imbalance, loss of coordination in the hands, or bowel and bladder dysfunction.

For example, one cervical spine MRI shows mild stenosis at the C5-6 disc space. There’s some narrowing but no cord compression.

Compare that to another MRI showing severe stenosis where the spinal cord is visibly compressed. That’s when symptoms and potential injury become a concern.

Stenosis isn’t limited to the central canal, either. It can also affect the foramina, those small tunnels where individual nerves exit the spine to reach your arms and legs.

Again, narrowing doesn’t always mean pinching. But if the space becomes too tight, the nerves can be compressed, leading to symptoms that may require treatment.

Other Causes of Spinal Stenosis

While aging and wear and tear are common causes of spinal stenosis, narrowing can also result from an acute disc herniation, cysts from the facet joints called synovial cysts, or spondylolisthesis, in which one vertebra slips over another.

Other causes include spine fractures, infections or abscesses, hematomas, and tumors.

Non-Surgical Treatment Options for Spinal Stenosis

The right treatment for spinal stenosis depends on several factors, including the cause of the narrowing, the location and severity of the stenosis, the patient’s age, overall health, and goals for recovery.

In many cases, especially when symptoms are mild, surgery isn’t the first step.

Non-surgical treatments can be highly effective and may include pain-relieving medications, physical therapy to improve mobility and strength, traction or decompression therapy, epidural steroid injections, acupuncture, or other integrative approaches.

These options aim to reduce inflammation, improve function, and relieve pressure on the nerves without altering the spine’s anatomy.

When Is Surgery Considered for Spinal Stenosis?

If symptoms are persistent, progressive, or significantly impact quality of life, surgery may be recommended to physically open up the space around the compressed nerves or spinal cord.

The goal is to relieve pressure and restore function.

Depending on the anatomy and severity, surgical procedures may include discectomy, which involves removing part or all of a damaged disc that’s pressing on the nerves.

A laminectomy involves removing the lamina, or back part of the vertebra, to widen the spinal canal.

A facetectomy involves trimming or removing part of the facet joint to relieve nerve compression. A corpectomy requires removing a portion of the vertebral body, often from the front of the spine, to decompress the spinal cord.

A spinal fusion may be required to stabilize the spine with hardware such as screws, rods, or cages to prevent movement and maintain alignment.

Each procedure is tailored to the patient’s unique anatomy and symptoms. There’s no one-size-fits-all approach, just a personalized plan designed to maximize relief and minimize risk.

Real-World Examples of Spinal Stenosis Surgery

To better understand how different procedures address spinal stenosis, let’s walk through a few real-world examples.

Cervical Corpectomy

One gentleman had severe central canal stenosis in his cervical spine extending behind the vertebrae.

A cervical corpectomy was performed to remove part of the vertebral body and decompress the spinal cord from the front of the spine.

A cage with a plate and screws was then placed to stabilize this level.

Anterior Cervical Discectomy and Fusion (ACDF)

One woman underwent an anterior cervical discectomy and fusion, or ACDF, to remove the disc and relieve pressure on her spinal cord and nerve roots exiting through the foramina at the adjacent levels.

Cervical Laminectomy With Posterior Fusion

In another case, a woman underwent cervical laminectomies combined with posterior instrumented fusion to relieve pressure on the spinal cord and stabilize the neck.

To decompress the spinal cord, a portion of bone called the lamina, located on the back arch of the vertebra, was carefully removed. This created more space around the spinal cord, reducing compression.

To ensure long-term stability, screws and rods were then placed along the back of the cervical spine, helping support proper alignment and prevent further movement at the affected levels.

Lumbar Microdiscectomy

One gentleman had a herniated disc fragment compressing his nerve roots.

A minimally invasive lumbar microdiscectomy was performed to remove only the offending fragment and preserve surrounding structures.

Lumbar Laminectomy With Fusion for Spondylolisthesis

One woman had a slipped vertebra causing central canal narrowing and severe nerve compression.

She underwent lumbar laminectomies with instrumented fusion to realign the spine and decompress the nerves.

Combined Anterior and Posterior Lumbar Fusion

One woman had small fractures in her spine causing slipped vertebrae and severe foraminal stenosis with nerve root compression.

She benefited from a staged approach involving an anterior lumbar discectomy and fusion, followed by a minimally invasive posterior fusion for added stability.

Why Spinal Stenosis Treatment Must Be Individualized

There’s no one-size-fits-all surgery for spinal stenosis.

Treatment must be highly individualized based on a thorough review of detailed spine imaging, physical examination, the patient’s medical history and overall health, and personal goals and lifestyle considerations.

The goal is to craft a surgical plan that’s both effective and aligned with the patient’s needs while minimizing risk and preserving function.

Understanding Your Spinal Stenosis Diagnosis

In sum, stenosis simply means narrowing, a common result of aging and natural wear and tear of the spine.

It doesn’t always require surgery, and in many cases, it can be managed with non-operative care. But when symptoms are severe or progressive, surgery may be considered.

When surgery is appropriate, the type and extent of the procedure are tailored specifically to the patient’s anatomy, symptoms, and goals.

Every spine is unique, and so is every treatment journey.

Whether you’re exploring options for yourself or supporting someone you love, understanding stenosis is the first step toward empowered decision-making.

Schedule a consultation with Dr. Kelly Bridges to discuss your options and find the right path forward for your spine health.