Diagnostic Testing for Spinal Stenosis
The symptoms caused by spinal stenosis can be similar to other spinal disorders, so it is important to learn what is causing your discomfort. The spine experts at Och Spine at NewYork-Presbyterian may take the following steps to diagnose spinal stenosis:
- Medical history to learn about your symptoms: when did they start, what makes them feel better or worse, how do they limit your activities? The doctor will also ask you about your family medical history and your activities.
- Physical and neurological exams to assess your range of motion, muscle strength, pain, and sensation.
- Imaging exams such as X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI). MRI is the best imaging method to see the discs and nerves in and around your spine. For a complete evaluation, however, X-rays are usually necessary in addition to MRI.
- A CT myelogram is a special CT scan performed after a dye is injected into the spinal fluid. This test is used when patients cannot get or tolerate an MRI — for example, patients who cannot get an MRI because they have a pacemaker.
- Electromyogram (EMG) and nerve conduction studies (NCS) measure electrical activity in the nerves and muscles. They may identify nerve damage or nerve compression. These studies are sometimes required in addition to MRI and X-rays.
Using imaging exams, your doctor will look at the degree of narrowing of the spinal canal to determine if you have spinal stenosis. The following measurements are a general guide and are taken into consideration with other imaging findings, results of the physical examination, and your medical history.
- For cervical stenosis diagnosis, the average space in the cervical spine is 14 mm; 11 mm or less indicates there is stenosis.
- For lumbar stenosis diagnosis, spinal stenosis is considered when the space measures 12 mm or less.
Non-Invasive Treatments for Spinal Stenosis
Depending on the severity of the narrowing in your spine, your doctor will tell you if you can treat spinal stenosis without surgery. If so, you may learn at-home exercises you can do to relieve your symptoms. You may also benefit from medications and/or physical therapy if your stenosis is mild.
At-home spinal stenosis exercises
There are certain exercises you can do at home to relieve the symptoms of mild spinal stenosis. Stretches for spinal stenosis can help you achieve better flexibility and mobility in your spine and reduce pressure on the nerves. You may also be advised to avoid certain back extension (arching) exercises that can compress the spinal space and aggravate spinal stenosis.
These exercises are often tailored to suit your indiviudal needs and goals. Call us to schedule an appointment with a highly specialized physical therapist for specific advice on at-home exercises for spinal stenosis.
Medications and injections for spinal stenosis
Over-the-counter medications such as acetaminophen and ibuprofen can help relieve the pain caused by spinal stenosis. You may receive a prescription medication to reduce inflammation or treat muscle spasms, or medications to treat nerve pain (such as gabapentin).
Another possible spinal stenosis treatment is the injection of a steroid drug and/or local anesthetic over the affected spinal nerves to reduce inflammation and relieve pain. This injection is performed with the guidance of medical imaging so the physician can safely insert the needle into the precise location of the stenosis. Typically, these are performed by physiatrists (also called physical medicine and rehabilitation (PM&R) doctors), anesthesiologists, or sports medicine doctors with specific expertise in pain management.
Physical therapy for spinal stenosis is commonly used to improve mobility in the spine, strengthen core muscles, and provide decompression to relieve nerve discomfort. Physical therapists can evaluate how you stand, walk, and sit, and suggest ways to change these habits to relieve your spinal stenosis symptoms. They help you learn about proper alignment of the spine and approaches to move safely while teaching ways to improve strength, posture, range of motion, and flexibility.
Components of physical therapy may include spinal stenosis exercises you learn with your therapist and continue at home to stretch and strengthen your muscles. Your physical therapist will teach you the specific exercises that are most effective for you.
Spinal Stenosis Surgery
Surgery may be considered if needed in an emergency to relieve spinal stenosis and restore bladder and bowel function or if paralysis is present. In other cases, it is reserved for patients whose symptoms cannot be relieved using nonsurgical techniques.
At Och Spine, we use minimally invasive surgery for spinal stenosis whenever appropriate, operating through very small incisions so your recovery can be quicker, and you can get back to doing your favorite activities sooner.
Endoscopic decompression. This technique requires only a small incision. A specially trained surgeon inserts a slender endoscope into the incision with a built-in wafer-thin camera and orients tools to the location of the stenosis under X-ray and direct visual guidance. The surgeon decompresses the nerve by opening the foramen (the passage through which the nerve passes). Many patients may go home the same day.
Lumbar decompression. This is one of the most common procedures used to treat spinal stenosis. We perform it using a minimally invasive approach whenever appropriate. The surgeon relieves compression in the spinal canal by removing a part of the bone and excess ligament that is creating pressure on the spinal cord or nerves. During a laminotomy, only part of the lamina is removed (the part of the vertebra that covers the spinal canal, which houses the spinal cord and nerves); the surgeon creates a hole that is just large enough to relieve the pressure in a specific location.
Anterior cervical discectomy and fusion. This minimally invasive procedure is used to treat a subset of patients with cervical stenosis and is the most common cervical spine procedure performed in America. A small incision is made on the side of the neck and with critical structures moved to the side, the surgeon can directly approach the front of the cervical spine without much cutting into the muscle. The discs and sometimes portions of the bone of the affected levels are removed using a high-powered microscope, taking pressure off of the spinal cord. This void is then replaced with a piece of bone or a small plastic or metal cage that is secured to keep it from moving. Depending on how many levels are fused, the range of motion may be somewhat reduced. Some patients, depending on their specific condition, can have cervical disc replacement, which does not require fusion and preserves range of motion.
Posterior cervical foraminotomy, laminectomy, or laminoplasty.
- If a single nerve is compressed, then a minimally invasive procedure called a foraminotomy can be performed through a small tube the size of a dime. Part of the bone is drilled off to create more room for the nerve, and sometimes if a disc herniation is present, it can be removed at the same time.
- A laminectomy is a more complex procedure used to treat severe cases of cervical spinal stenosis. The pressure on the spine is decreased by removing the portion of the vertebra that is compressing the spine and nerves. In some cases, rods and screws are inserted with bone grafts to stabilize the neck and fuse the vertebrae. The fusion reduces some range of motion in the neck but brings relief to symptoms.
- In other cases, a portion of one side of the lamina is removed and slightly opened, and secured in place with small titanium plates to preserve the new, expanded canal. This procedure, called a laminoplasty, helps relieve pressure on the spinal cord and does not result in fusion or restricted range of motion.
Lumbar spinal fusion. If nonsurgical and other surgical techniques are not effective for treating spinal stenosis, fusing two vertebrae so there is no longer any motion between them may be an option. This reduces spinal pressure, pain, and nerve damage. In many cases, our surgeons use minimally invasive techniques with a computerized image guidance system and small incisions to perform the surgery. This unites the two vertebrae while avoiding injury to nearby delicate nerve tissue.
Receive Personalized Spine Care at Och Spine at NewYork-Presbyterian
Spinal stenosis can range from mild and annoying to severe and debilitating. Put your care in the hands of spine specialists with the knowledge, experience, and understanding to provide the treatment you need, relieve your symptoms, restore your function, and return you to the quality of life you desire.
You can find that team at Och Spine. Whether you can get by with at-home exercises and self-care or require a complex spine operation, we have all the experts you need to get better.
Schedule an appointment with one of our team members.