Symptoms of spinal stenosis
Spinal canal stenosis is a narrowing of the spinal canal with compression of the spinal cord and nerve roots.
Elderly people are mainly affected due to bone wear and bone additions. In most cases, either the lumbar spine or the cervical spine is affected. Spinal stenosis rarely affects the thoracic spine. Depending on the location, pain and, if necessary, abnormal sensations in the legs or arms, which are dependent on the load and posture.
The most important symptoms are listed below and then explained in more detail. Depending on the area of the spinal stenosis, however, different symptoms occur.
- Leg pain
- a headache
- Muscle weakness
When spinal stenosis causes symptoms, pain usually comes first. This can occur as back pain on the one hand in the area where the stenosis is located, i.e. mainly in the lumbar or cervical spine.
On the other hand, the pain often radiates and is mainly felt in the legs, as the nerve tracts coming from there are squeezed. It is also typical that the symptoms initially appear during exertion such as when walking. However, the pain alone is by no means proof of the presence of spinal stenosis.
Back pain in particular is a very common symptom and in most cases no medical cause of the symptoms can be identified. However, if the pain that is typical of spinal stenosis occurs, diagnostics using imaging methods can be considered, provided that this has a consequence for the treatment of the patient.
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Typical of spinal stenosis are leg pain that occurs during exertion, such as when walking.
Often the person concerned even has to stop and pause because of pain in their legs. The legs often feel heavy and tired. The symptoms are provoked most strongly when the upper body is leaning back, as is the case, for example, when running downhill. Walking uphill and cycling, on the other hand, are usually not a problem.
Leg pain is also a typical symptom of spinal stenosis, but only one of many possible causes. In the case of new leg pain, a medical examination is therefore always required to differentiate it from other diseases such as a circulatory disorder or venous disease.
Headache is generally a very common symptom with a variety of possible causes, although these are not typical symptoms of spinal stenosis.
In very rare cases it is possible that spinal stenosis in the cervical spine area leads to radiating pain in the head area. However, other causal diseases are significantly more likely. Common causes of headaches are, for example, tension headaches or migraines.
In spinal canal stenosis, tingling may occur due to pinched nerve roots. However, such complaints are much less common than the pain typical of the disease.
A tingling sensation usually occurs gradually if the patient has been suffering from pain while walking for a long time. The tingling sensation as a symptom of spinal stenosis is mostly localized in the legs or feet. If the cervical spine is affected, the symptom can also appear on the arms or hands.
Very advanced spinal stenosis can in rare cases cause numbness.
This can mainly occur on the legs or in the area of the soles of the feet. However, the prerequisite for this is that nerve fibers are so narrowed that they can no longer conduct signals. However, in most patients with spinal stenosis, the disease does not progress that far.
Nevertheless, numbness, especially in the area of the soles of the feet, is a common symptom that occurs especially in older people. Often, however, the cause is damage to small nerve fibers far away from the spinal cord, for example due to diabetes, and not the spinal canal stenosis.
Paralysis indicates severe nerve damage, which in principle can also occur due to severe spinal stenosis. However, other causes of paralysis are more likely and may need to be identified in good time.
A sudden onset of paralysis of an arm or leg is always an alarming sign of a stroke, especially in older patients, so that an emergency doctor must be called immediately if these symptoms occur. Other typical symptoms can be a sudden speech disorder and a hanging face on one side. The paralysis caused by spinal stenosis, on the other hand, is much rarer and does not set in suddenly but slowly.
Also read: These are the symptoms you can tell if you have a stroke such as Paralysis in the leg
Many patients with spinal stenosis complain of pain in the legs when walking, weakness and a feeling of heaviness in the legs.
This is due to the fact that the nerve tracts that control the muscles are narrowed during the disease. The patient then perceives this as muscle weakness. In spinal canal stenosis, however, an actually measurable reduction in strength of the leg muscles does not initially occur.
You may also be interested in this topic: Heavy legs - what to do?
Symptoms of the cervical spine
In spinal stenosis of the cervical spine, the symptoms primarily occur in the hands and arms.
This can be explained by the fact that the nerve tracts, which are responsible for the supply of hands and arms, originate in the cervical spine area of the spinal cord. There are nerve fibers that convey sensations in the arms such as touch, temperature or pain to the brain, as well as other nerves that send signals from the brain in the opposite direction to control the muscles and thus to move the arms. If, due to a spinal stenosis of the cervical spine, compression of the nerve roots exiting there occurs, this can initially be expressed, for example, by increasing clumsiness of the hands. This can be noticed by difficulty buttoning your shirt, threading a needle, or grasping small objects. Often the typeface also changes.
If the spinal stenosis progresses, objects can fall out of the hand, such as the coffee cup at breakfast.
Some patients also suffer from an unsteady gait in the advanced stages of the disease. Many sufferers report a feeling “like wood or cement” in their legs and the gait pattern is wide-legged.In addition, abnormal sensations such as tingling or pins and needles can occur on the arms and hands. However, none of the symptoms described here clearly suggest spinal stenosis of the cervical spine as the cause. There are a variety of possible explanations or underlying diseases for these unspecific symptoms. Therefore, if you have any complaints, you should consult a doctor who can make the diagnosis through targeted examinations.
More information on this topic: Spinal canal stenosis in the cervical spine
Symptoms of the thoracic spine
Spinal stenosis of the thoracic spine (BWS) is an extremely rare clinical picture, which is also known as thoracic spinal stenosis.
Even if this is not caused by wear and tear, like spinal stenosis of the lumbar spine, the resulting symptoms are similar. Unsteady gait and gait disturbances often occur. Sensory disturbances in the trunk area can also occur. Another possible symptom is a disorder of the urination of the bladder and bowel. Back pain is also an accompanying symptom.
It is typical of the rare spinal canal stenosis in the thoracic spine that the symptoms are much more pronounced than if the stenosis was localized in the lumbar spine. Ultimately, a possible stenosis of the spinal canal can only be discovered through an imaging procedure.
Symptoms of the lumbar spine
The lumbar spine is the area where spinal canal stenosis most commonly develops.
The main symptom is pain in the legs and back. These are load-dependent and usually start when walking a certain distance or when standing for longer. It is also typical that the symptoms are relieved or disappear completely when the hips are bent, such as when sitting or when the upper body is bent forward.
Those affected often report that the pain starts particularly when going downhill, whereas going uphill causes less discomfort. In addition, many patients can often still ride their bikes without problems despite pain-related restrictions on walking distance, since their upper body is also inclined here. In this position the spinal canal is less narrow and the symptoms of the stenosis do not appear. The symptoms described are also referred to as intermittent spinal claudication. Although this is typical of spinal stenosis of the lumbar spine, it does not occur in every patient with the disease.
A distinction must be made between the frequent “intermittent claudication”, which is caused by a circulatory disorder in the legs. Here, too, the walking distance is usually limited due to the onset of pain. While standing still in this condition usually eases the pain, a patient with spinal stenosis often has to sit down for the symptoms to subside. In some cases, spinal stenosis of the lumbar spine not only causes pain symptoms but also deficits in the legs. The most common sensations or numbness that can affect the entire leg and genital area. Only in extremely rare cases can symptoms of pronounced spinal stenosis of the lumbar spine ultimately lead to paralysis.
Also read: Spinal canal stenosis in the lumbar spine
From which symptoms do you have to have an operation?
In some cases, spinal stenosis can be so severe that the symptoms cannot be adequately alleviated by all conservative measures, including highly effective pain relievers.
In the case of steadily increasing severe pain lasting for months, surgical widening of the spinal canal can be considered as a last resort. This option is particularly relevant if it prevents the threat of severe nerve damage. This can be expressed, for example, by numbness, which does not only occur during exercise. Paralysis and a loss of control over bladder and rectal function can also be symptoms of pronounced nerve damage that could benefit from timely surgery.
However, it must always be borne in mind that a surgical procedure due to spinal stenosis involves many risks and complications occur in around one in five cases. Before undertaking such a serious procedure, it is therefore important to weigh up the potential benefits and risks together with the doctor. When making the decision, age and life expectancy as well as possible concomitant diseases should be taken into account in addition to the level of suffering. In addition, there is no scientific evidence that patients over 65 years of age with spinal stenosis even benefit from an operation.
More on this: Operation of the spinal stenosis