Types of Spinal Stenosis: Symptoms, Causes, and Treatment Options

If you’re among the 16 million Americans suffering from chronic back pain, you may be aware of spinal stenosis. As one of the many spine conditions that can cause chronic pain, spinal stenosis can cause lasting discomfort and even mobility issues, in advanced cases. It occurs when the spinal canal (which encloses the spinal cord and nerve roots) narrows, eventually causing nerve irritation and inflammation.

Multiple types of spinal stenosis exist, and understanding the differences between them can help you receive the proper care for your pain. In this article, we’ll explore the main types of spinal stenosis, as well as the notable symptoms, causes, and treatment options for this condition. 

What Are The Three Types of Spinal Stenosis?

The three types of spinal stenosis are lumbar, thoracic, and cervical. These distinctions refer to the area of the spine the condition affects. 

Thoracic spinal stenosis affects the middle of the spine, while cervical spinal stenosis affects the neck. Cervical stenosis is more common than thoracic, but neither is as prevalent as lumbar stenosis. 

Lumbar Spinal Stenosis

Lumbar spinal stenosis impacts an estimated 11% of American older adults. It occurs when the section of the spinal canal extending through the lower back narrows.

In the early stages, lumbar spinal stenosis may not cause any symptoms. However, as the spinal canal progressively narrows, it can impinge on spinal nerve roots or the spinal cord, leading to lower back pain and neurological symptoms. 

Lumbar is the most common type of spinal stenosis for a variety of reasons:

  • The lumbar spine supports more of your body weight than the mid or upper spine, acting as a base for your upper body. This causes it to exhibit signs of spinal degeneration faster, including spinal stenosis. 
  • The lumbar spine is more flexible than other parts of the spine, making it more prone to strain and overuse. 
  • Poor posture often affects the lumbar spine significantly, especially for individuals with sedentary lifestyles. 
  • The lumbar spine participates in many day-to-day motions, like bending and twisting. These movements contribute to degeneration over time. 

Foraminal vs. Central Canal Stenosis

Spinal stenosis may also be categorized as foraminal or central canal stenosis. These types refer to the region of the spinal canal affected by the condition. 

  • Foraminal stenosis affects the intervertebral foramen of the spine, which are the small, bony openings through which nerves leave the spinal canal. When a foramen narrows, it may impinge on the nerve traveling through it, leading to neurological symptoms. 
  • Central canal stenosis occurs when the bony opening running through the middle of the vertebrae, called the vertebral foramen, narrows. The vertebral foramen encircles the spinal cord, helping to protect it from damage. But, when it’s affected by central canal stenosis, it may press on the spinal cord, causing spinal stenosis symptoms. 

Congenital vs. Degenerative Spinal Stenosis

Spinal stenosis can be caused by different factors, including genetics and spinal wear and tear. Congenital spinal stenosis is caused by genetic factors, while degenerative spinal stenosis is caused by wear and tear. 

  • Congenital spinal stenosis occurs when someone is born with an abnormally narrow spinal canal. It’s relatively rare, but when it does happen, the affected patient tends to develop degenerative spinal issues sooner in life than usual. 
  • Degenerative spinal stenosis is much more common, accounting for up to 90% of reported spinal stenosis cases. It results from repeated impact on the spine over time, causing inflammation and tissue damage. Changes that naturally affect the spine with age, such as thickened spinal ligaments, can also contribute to degenerative spinal stenosis.
    • Degenerative stenosis can sometimes be referred to as “acquired” spinal stenosis. However, this term also encompasses stenosis caused by injuries, such as:
      • Vertebral fractures
      • Vertebral dislocations
      • Ruptured spinal discs

What Are The Symptoms of Spinal Stenosis?

The symptoms of spinal stenosis include:

  • Back pain that may feel burning, aching, or radiate into the extremities
  • Back pain that worsens when you walk or stand, particularly for long periods
  • Numbness, cramping, and tingling in the lower extremities
  • A heavy sensation in the legs and “foot drop”, the term used for the foot slapping onto the ground when you try to walk
  • Loss of balance or coordination

Typically, these symptoms worsen gradually over time, becoming disruptive to daily activities in the later stages. 

The Worst Symptoms of Spinal Stenosis

The worst symptoms of spinal stenosis include bladder or bowel dysfunction, sexual dysfunction, loss of motor function in the legs, and lost sensation in the saddle region. 

These symptoms indicate that lumbar spinal stenosis has progressed to cauda equina syndrome or CES. This is a medical emergency that requires immediate care to prevent permanent paralysis. It occurs when the narrowing spinal canal compresses the cauda equina, a sac of nerve roots at the base of the spinal cord. The cauda equina includes nerves that affect bladder, bowel, and sexual function. 

What Are the Four Stages of Spinal Stenosis?

The four stages of spinal stenosis are no stenosis, mild, moderate, and severe. This is also known as the Lurie grading system for spinal stenosis. 

  • None: The spinal canal is normal and hasn’t been noticeably narrowed. 
  • Mild: The area is compromised to a degree of ⅓ or less of its normal size. Symptoms of this stage of spinal stenosis, if it causes any symptoms, may include:
    • Mild back pain that improves when you lean forward
    • Mild tingling or numbness with long periods of standing or walking
  • Moderate: The area is compromised between ⅓ and ⅔ of its normal size
    • Moderate back pain that flares up when you stand or walk for long periods
    • Numbness, tingling, and/or weakness that radiates to the extremities
  • Severe: The area is compromised to a degree of over ⅔ of its normal size
    • Significant back pain that disrupts your daily routine
    • Significant neurological symptoms, including numbness, tingling, and weakness 
    • Discomfort while sitting and standing for any length of time
    • Difficulty balancing, especially while walking

Early intervention is key to slowing spinal stenosis progression. If you experience back pain that doesn’t go away after a few weeks of at-home care, visit your doctor for an evaluation. Your doctor may recommend physical therapy and lifestyle adjustments to treat mild spinal stenosis, or a comprehensive treatment plan for more advanced cases. 

How to Prevent Spinal Stenosis

To prevent spinal stenosis or slow its progression, you can exercise regularly, improve your posture, maintain a healthy weight, lift heavy objects carefully, quit smoking, and adopt a nutritious diet. 

Exercise to Prevent Spinal Stenosis

Exercising at least a few days per week with low-impact activities, like walking, swimming, and cycling, can prevent spinal stenosis by preserving your mobility. Exercise also promotes strong core and back muscles, which help support the lumbar spine. Targeted strengthening exercises can also help bolster these muscle groups to prevent excessive impact on the lower spine. 

Improved Posture for Spinal Health

Your posture has a considerable impact on your spinal health as a whole. Improving your posture—especially if you’re seated for most of the workday—can prevent excessive strain on the lumbar spine. Sit up straight, keep your screen at eye level, and purchase a desk chair with lumbar support. Additionally, avoid having a sedentary lifestyle, and take breaks from sitting every 30 minutes or so. 

Maintain a Healthy Weight

Extra pounds place extra impact on the lower spine, increasing the risk of inflammation and degeneration. Regular exercise will help keep you in shape, as will a nutritious diet. 

Eat a Nutritious Diet

Good nutrition can help ward off degenerative spinal conditions by preventing systemic inflammation and preserving bone health. Increase your intake of leafy greens, vegetables, fruits, fatty fish, whole grains, and nuts. Limit foods that can trigger the body’s inflammatory processes, such as fried food, processed foods, added sugars, and red meat. 

Quit Smoking

Smoking can sabotage your spinal health, as nicotine is a vasoconstrictor. This means it narrows your blood vessels, reducing blood flow throughout the body. Smoking may speed up spinal degeneration and compromise your body’s ability to heal damaged tissue. 

Be Careful With Heavy Lifting

If you need to lift heavy objects, either in your career, workouts, or while moving houses, for example, be careful! Enlist help if an object is too heavy for you to lift safely, and implement proper lifting posture. Use your leg muscles to squat and keep your spine straight. 

Spinal Stenosis Treatment Options Depending on the Disease Severity

Your spinal stenosis treatment options will vary depending on the disease severity. While mild to moderate cases can be managed with non-invasive treatments, severe spinal stenosis often requires surgery. 

Treatments for Mild Spinal Stenosis

Mild spinal stenosis can usually be successfully managed with conservative methods, like:

  • Heat and cold therapy to manage inflammation, stiffness, and pain
  • Over-the-counter pain medications to limit day-to-day discomfort (in the short term)
  • Physical therapy to improve muscle strength, enhance range of motion, and correct poor movement patterns
  • Lifestyle changes, such as an exercise routine, quitting smoking, and limiting high-impact movements

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Treatments for Moderate Spinal Stenosis

If you have moderate spinal stenosis, you’ll need a more extensive treatment plan than patients with mild forms of the disease. However, surgery isn’t typically required at this stage. Your treatment plan may include methods like:

  • Physical therapy
  • Medication, including over-the-counter and/or prescription drugs
  • Back bracing, which can help prevent overextending the spine
  • Epidural steroid injections to curb inflammation in the affected area
    • Note that this treatment must be used sparingly to prevent tissue atrophy.
  • Transcutaneous electrical nerve stimulation, or TENS, which stimulates the body’s production of endorphins, naturally relieves pain, and reduces muscle tension
  • Massage therapy and/or acupuncture to calm muscle tension and improve your mobility

Treatments for Severe Spinal Stenosis

Severe spinal stenosis usually hasn’t responded to several months of conservative treatments, like physical therapy, spinal injections, and pain medications. This leaves surgery as the remaining option to alleviate your pain and prevent immobility. 

In the past, patients had a relatively limited range of procedures to consider. Spinal decompression surgery with fusion is the standard option, although spinal fusion limits mobility at the fused segment. This can also lead to adjacent segment disease, which damages the vertebrae above and below the fusion. 

Now, patients with lumbar spinal stenosis can consider minimally invasive options, including the TOPS System. This non-fusion spinal implant is inserted to replace the tissues removed in spinal decompression, creating a controlled range of motion. With TOPS, the spine can move in all directions without the risk of instability. 

If you’re struggling with spinal stenosis at any stage, contact a physician in your area to learn more about your treatment options.