If you’re experiencing lower back or neck pain with ankylosing spondylitis (AS), you may wonder if you also have spinal stenosis. As one MySpondylitisTeam member wrote, “Does anyone else have spinal stenosis and resulting leg numbness/pain/weakness when walking?”
Ankylosing spondylitis is a form of arthritis that affects the bones in the spine, also known as vertebrae. Arthritis occurs when the cells of the immune system become overactivated or inflamed. This inflammation can wear down the bones, leading to extra growth and fusion of bones. Some people with AS may also develop spinal stenosis, so it’s important to differentiate the symptoms of the two conditions.
Here are four things to know about ankylosing spondylitis and spinal stenosis.
Like ankylosing spondylitis, spinal stenosis affects the spine. In spinal stenosis, the spinal canal has thinned and narrowed, which compresses and puts pressure on the spinal cord. The spinal canal is the space that runs along the spinal column that protects the spinal cord (the large nerve that carries messages from your brain to the rest of your body). The spinal column refers to the line of vertebrae that start at your lower back and continue to your neck.
In lumbar spinal stenosis, the spinal nerve roots are compressed. The spinal roots are located in the lower portion of the spine, called the lumbar spine. In cervical spinal stenosis, the upper vertebrae by the neck are compressed.
The symptoms of spinal stenosis, depending on the region affected, include:
Symptoms can range from a dull ache to sharp, intense pain.
Some of the symptoms of ankylosing spondylitis, including neck pain and lower back pain, overlap with those of spinal stenosis. AS pain results from inflammation, so it usually improves with movement, but spinal stenosis triggers mechanical pain — it arises from stress on bones, disks, or nerves in the spine — and may feel worse with movement.
If you’ve developed spinal stenosis along with your ankylosing spondylitis, know that you’re not alone. Many MySpondylitisTeam members have shared their experiences with spinal stenosis.
“My AS has gotten so bad that it is causing spinal stenosis,” one member wrote. Another said, “Spinal stenosis is what is causing most of the pain in my back.”
Community members report chronic pain and discomfort with their spinal stenosis.
Some people are born with spinal stenosis, but most people develop it over time. Risk factors include conditions that place a burden on the vertebrae. These conditions include a combination of the following:
Up to 95 percent of people over 50 develop degenerative spinal changes, including spinal stenosis. However, it’s unknown just how many individuals with ankylosing spondylitis also have spinal stenosis.
Inflammation in ankylosing spondylitis wears down the bone and puts pressure on the nerves, resulting in many risk factors that are also involved in spinal stenosis. Worn-down bones can lead to fractures, with subsequent regrowth of bone and ligaments.
Accordingly, spinal fractures and osteoarthritis are common complications of ankylosing spondylitis and are also risk factors for developing spinal stenosis.
To reduce pain associated with spinal stenosis, you can try lifestyle changes, such as:
However, you’ll likely need doctor-directed strategies, too. Your health care provider may recommend a treatment plan for spinal stenosis that involves a combination of therapies, such as exercise, medication, and both nonsurgical and surgical procedures. Many of these approaches are also used for spondylitis.
In spinal stenosis, regularly performing certain types of exercise can lessen the intensity of the pain. Because movement can be challenging, activities such as strength training, light stretching, gentle walking, and swimming may be preferred.
While movement is widely considered part of the treatment for spinal stenosis, there isn’t a lot of research to support a specific exercise program. Working with your health care provider or a physical therapist can help ensure you’re following a safe, effective routine.
Medications for spinal stenosis include a combination of over-the-counter (OTC) drugs, prescribed medications, and injections.
The most commonly used OTC medications are nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and naproxen (Aleve). NSAIDs are typically the first option for pain management and can be helpful for many conditions that cause lower back pain.
Medications for spinal stenosis may include gabapentin (Neurontin), an anti-seizure medication that stops unwanted nerve activity. “I didn’t realize how much the gabapentin helped until I stopped using it for a few days,” wrote one MySpondylitisTeam member regarding their spinal stenosis treatment plan.
Medications that relax muscles also can ease pain and discomfort. Certain depression medications have also been useful in managing spinal stenosis.
Corticosteroid injections can help reduce inflammation and manage pain with spinal stenosis. These injections are often put directly into the space around the spinal cord, known as the epidural space. They’re often referred to as epidural injections or steroid injections.
MySpondylitisTeam members have shared their spinal stenosis treatment plans and reported varying levels of success, including with use of injections. “They are doing a back injection for me,” one member wrote. “I’ve had many with no pain relief at all.”
Nonsurgical options include massage and acupuncture (an alternative treatment that uses small needles to relieve pain and pressure). Both of these therapies may be recommended for pain management of spinal stenosis.
Various surgical procedures are used to improve the quality of life for individuals living with spinal stenosis.
Laminectomy, a type of spinal surgery for ankylosing spondylitis, might be used to treat spinal stenosis. In this procedure, bones called lamina are removed from the spinal column. This relieves pressure on the nerves that are being compressed. Between 45 percent and 72 percent of individuals who get this procedure are satisfied with the treatment.
In a laminotomy, just a portion of the lamina is removed. The aim is to take out the part of the bone that’s compressing the nerve.
Many people live with spinal stenosis for years with no change in symptoms. However, this condition can cause pinched nerves in the leg, known as sciatica, which can also occur with spondylitis. In rare, severe cases, spinal stenosis can cause leg paralysis (complete or partial loss of function). This is because the nerve root has been too damaged to continue to work. This type of damage can also cause a lack of control of the bowel and bladder.
If you suspect you have spinal stenosis, you should talk with your rheumatologist. Although some treatments for spinal stenosis and ankylosing spondylitis may overlap, the best plan will involve shared decision-making with your physician.
MySpondylitisTeam is the social network for people with spondylitis and their loved ones. On MySpondylitisTeam, more than 93,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.
Have you or a loved one been diagnosed with both spondylitis and spinal stenosis? How have you managed the symptoms of these conditions? Share your experience in the comments below, or start a conversation by posting on your Activities page.