chemically irritating the spinal nerve. Leg pain from a herniated disc usually radiates along the course of a spinal nerve and is present even at rest. In contrast, the pain from spinal stenosis radiates over the course of more than one nerve and is relieved by sitting or bending over. The ability to bend over at the waist while standing and to lift the symptomatic leg up while lying face up is limited by a herniated disc. Bending and straight-leg raising are not limited and in fact may relieve the pain from spinal stenosis.
A disc herniation may contribute to spinal stenosis, particularly when it occurs in the lateral recess or foramen of the spinal canal. This can happen when a disc herniation occurs in a small or misshapen spinal canal. The normal spinal canal is triangular in shape and the diameter of a quarter. Approximately 10 percent of people are born with a cloverleaf-shaped spinal canal that approaches the size of a nickel or smaller. This is called congenital spinal stenosis. Smaller degenerative changes in the disc and facet joints may result in more significant encroachment on a misshapen or small spinal canal than they would on a normally shaped and sized spinal canal. This is particularly true in the lateral recess, that area on the side of the spinal canal where the nerves just begin to enter the channel to exit the canal. A small disc bulge or herniation in a congenitally small lateral recess may result in severe leg pain, whereas it would cause no symptoms in a normal lateral recess. Lateral-recess stenosis with a disc herniation may cause a combination of the classic symptoms and physical findings seen with either condition alone.
A typical symptom of lateral-recess stenosis is leg pain with rotation of the spine, such as at the end of a golf swing. I once operated on a famous professional golfer who had pain at the end of her golf swing that was seriously affecting her ability to compete. I performed a surgical decompression of one lateral recess and she was able to continue playing on the international circuit. I took care of a college soccer player who had sciatic leg pain when he kicked the ball. He had spinal stenosis localized to one lateral recess. I surgically decompressed his lateral recess and he went on to become a professional player in Europe.
Other causes of spinal stenosis
Constriction of the spinal canal can result from conditions other than disc degeneration, congenital small canal, and disc herniation. Cysts can form on degenerated facet joints similar to the cysts that form on arthritic finger joints. They are called facet-joint cysts or synovial cysts of the facet joint. These cysts can cause spinal stenosis and produce aching symptoms in the legs. They usually occur in the lumbar spine, but I have seen them in the cervical and thoracic spine as well. They are benign, not cancerous, and rarely recur after they are surgically removed.
Paget’s disease is a condition that causes bones to thicken and joints to become arthritic. Paget’s disease can involve the vertebrae, facet joints, and lamina of the spine, resulting in a severe form of spinal stenosis.
This MRI scan of the low back, side view, shows the spinal canal that has been constricted (spinal stenosis) by a bulging disc, slippage of the spine, and a facet joint cyst. There are two other herniated discs (HNP), one large and one smaller. It is unusual to see all of these conditions in the same patient.
Very slow-growing benign tumors of the nerves inside the spinal canal (neurofibroma, schwannoma) can constrict the space for the remaining nerves and cause symptoms typical of spinal stenosis. However, these tumors are usually associated with progressively severe night pain that disturbs normal sleep patterns. Although most people have night pain with spinal stenosis, it is relieved by certain positions, such as sleeping on your side with your legs curled up.
Some small people, such as those born with achondroplasia, can have
A disc herniation may contribute to spinal stenosis, particularly when it occurs in the lateral recess or foramen of the spinal canal. This can happen when a disc herniation occurs in a small or misshapen spinal canal. The normal spinal canal is triangular in shape and the diameter of a quarter. Approximately 10 percent of people are born with a cloverleaf-shaped spinal canal that approaches the size of a nickel or smaller. This is called congenital spinal stenosis. Smaller degenerative changes in the disc and facet joints may result in more significant encroachment on a misshapen or small spinal canal than they would on a normally shaped and sized spinal canal. This is particularly true in the lateral recess, that area on the side of the spinal canal where the nerves just begin to enter the channel to exit the canal. A small disc bulge or herniation in a congenitally small lateral recess may result in severe leg pain, whereas it would cause no symptoms in a normal lateral recess. Lateral-recess stenosis with a disc herniation may cause a combination of the classic symptoms and physical findings seen with either condition alone.
A typical symptom of lateral-recess stenosis is leg pain with rotation of the spine, such as at the end of a golf swing. I once operated on a famous professional golfer who had pain at the end of her golf swing that was seriously affecting her ability to compete. I performed a surgical decompression of one lateral recess and she was able to continue playing on the international circuit. I took care of a college soccer player who had sciatic leg pain when he kicked the ball. He had spinal stenosis localized to one lateral recess. I surgically decompressed his lateral recess and he went on to become a professional player in Europe.
Other causes of spinal stenosis
Constriction of the spinal canal can result from conditions other than disc degeneration, congenital small canal, and disc herniation. Cysts can form on degenerated facet joints similar to the cysts that form on arthritic finger joints. They are called facet-joint cysts or synovial cysts of the facet joint. These cysts can cause spinal stenosis and produce aching symptoms in the legs. They usually occur in the lumbar spine, but I have seen them in the cervical and thoracic spine as well. They are benign, not cancerous, and rarely recur after they are surgically removed.
Paget’s disease is a condition that causes bones to thicken and joints to become arthritic. Paget’s disease can involve the vertebrae, facet joints, and lamina of the spine, resulting in a severe form of spinal stenosis.
This MRI scan of the low back, side view, shows the spinal canal that has been constricted (spinal stenosis) by a bulging disc, slippage of the spine, and a facet joint cyst. There are two other herniated discs (HNP), one large and one smaller. It is unusual to see all of these conditions in the same patient.
Very slow-growing benign tumors of the nerves inside the spinal canal (neurofibroma, schwannoma) can constrict the space for the remaining nerves and cause symptoms typical of spinal stenosis. However, these tumors are usually associated with progressively severe night pain that disturbs normal sleep patterns. Although most people have night pain with spinal stenosis, it is relieved by certain positions, such as sleeping on your side with your legs curled up.
Some small people, such as those born with achondroplasia, can have
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