Preventing Complications of Spinal Stenosis

Content medically reviewed by Carlos Goulart, MD

Back pain is a common condition that affects most of us at some point in our lives. As we get older, a common reason for back pain is spinal stenosis, a narrowing of the spinal canal that can put pressure on the nerve roots. Spinal stenosis becomes more likely with age, but treatment can often help ease symptoms. If the condition is left untreated, however, it can lead to major complications that can affect the quality of your life.

“Spinal stenosis is not entirely preventable, but you should never ignore symptoms,” said Dr. Carlos Goulart, a neurosurgeon at Essentia Health. “Many different treatment options are available that can relieve pressure on spinal nerves, improve symptoms, and prevent complications.”

How Does Spinal Stenosis Develop?

Your spinal cord is a bundle of nerves extending from the base of the brain and running down the center of the spine. The vertebral canal usually provides enough space for the spinal cord and nerves. However, age-related changes, like bone spurs, thickened ligaments, arthritis, herniated discs, and other conditions, can cause this space to narrow. Spinal stenosis usually happens in the lumbar spine (the lower back) or the cervical spine (the neck).

Symptoms vary depending on the location in the spine. Signs of lumbar spinal stenosis include –

• Lower back pain
• Burning or aching pain that travels from the buttocks into the legs
• Cramping, numbness, or tingling in the legs or feet that gets worse when walking or standing and improves when sitting and leaning forward
• Weakness in legs and feet

For cervical spinal stenosis, common symptoms include –

• Pain in the neck
• Numbness or tingling in the arms that radiates down into the hands
• Weakness in an arm, hand, or fingers

Why Spinal Stenosis Needs Treatment

Symptoms of spinal stenosis often start slowly and get worse over time. Without treatment, lumbar spinal stenosis can become severe and lead to a condition called cauda equina syndrome (CES). The cauda equina, a group of nerves at the end of the spinal cord in the upper part of the lower back, contains nerve roots that control motor and sensory functions to the legs and bladder. The narrowing of the spinal canal from stenosis can cause many of these nerves to malfunction.

Depending on which nerve roots are affected, complications that can develop from CES include –

• Urinary incontinence. Your bladder can become overfull because you cannot feel the urge to urinate, a condition called urinary retention. You may then not be able to hold your urine.
• Bowel incontinence. You may be unable to control when you need to have a bowel movement due to the anal sphincter not working as it should.
• Saddle anesthesia. Nerve compression can lead to numbness in the perineum. In females, this is the area between the anus and the vulva; in men, it is the area between the anus and the scrotum. 
• Trouble walking. You may develop weakness in nerves that affect your legs and feet, making it more difficult to walk.
• Paralysis. As nerves become more compressed over time, your legs could become partially or completely paralyzed.
• Problems with sexual function. Men with spinal stenosis often experience erectile dysfunction, the inability to get an erection. Some women experience pain with sex. 
• Sciatica. Spinal stenosis can affect the sciatic nerve, which controls sensation in the back of the thigh, part of the lower leg, and the sole of the foot. Pressure on this nerve can lead to pain, tingling, numbness, and weakness in the lower back that can radiate down the leg and even into the foot and toes.

Lumbar spinal stenosis is not life-threatening. But when CES develops, symptoms can become so severe that they lead to disability. In some cases, permanent nerve damage can occur. CES requires emergency surgical treatment to prevent permanent paralysis and incontinence.

Treatment Options to Slow Spinal Stenosis

Fortunately, many people will find that symptoms of spinal stenosis improve with treatment, and severe complications can often be avoided. Many nonsurgical options are available that can slow disease progression and improve quality of life. These include –

• A back brace. Bracing can provide support, taking some of the pressure off nerves and helping you become more mobile.
• Complementary treatments. Some people may benefit from seeing a chiropractor or acupuncturist.
• Medications. Pain-relieving and anti-inflammatory medications can help manage symptoms. Your provider might recommend over-the-counter medicines or prescribe medications for more severe pain.
• Physical therapy and exercise. Physical therapy can help stabilize your spine through exercises that strengthen the back and abdominal muscles. Your physical therapist may also encourage you to gradually begin aerobic exercise, such as swimming or using a stationary bike.
• Steroid injections. If other pain-relieving medicines don’t provide relief, getting epidural steroid injections can help control pain and inflammation.

If other treatments don’t work or symptoms become debilitating, your provider might recommend surgery to relieve pressure on nerves or restore spine alignment. Surgeries that can treat spinal stenosis include –

• Laminectomy. In this surgery, the surgeon can open the spinal canal by removing bone spurs and bone walls of vertebrae. If you have a herniated disc, the surgeon can also perform a discectomy to remove part of the disc and relieve nerve pressure.
• Spinal fusion. This procedure fuses together vertebrae that have slipped out of position. The surgeon may remove discs and join bones using bone grafts or metal devices.

“At Essentia Health, we offer minimally invasive, robotic surgery options for better precision and faster recovery times,” Dr. Goulart said. “Talk to your provider about your options.”

For most people, surgery relieves pain and allows for better mobility, allowing you to enjoy activities you may not have been able to do before. But some symptoms may still be present or reappear later as the disease progresses.