Spinal stenosis

Definition

Spinal stenosis is narrowing of the spinal column that causes pressure on the spinal cord, or narrowing of the openings (called neural foramina) where spinal nerves leave the spinal column.

Alternative Names

Pseudo-claudication; Central spinal stenosis; Foraminal spinal stenosis; Degenerative spine disease; Back pain - spinal stenosis

Causes

Spinal stenosis usually occurs as a person ages.

Spinal stenosis may also be caused by:

Symptoms

Symptoms often get worse slowly over time. Most often, symptoms will be on one side of the body, but may involve both legs.

Symptoms include:

Symptoms are more likely to be present or get worse when you stand or walk. They often lessen or disappear when you sit down or lean forward. Most people with spinal stenosis cannot walk for a long period.

More serious symptoms include:

Exams and Tests

During a physical exam, your doctor will try to find the location of the pain and figure out how it affects your movement. You will be asked to:

Your doctor will also move your legs in different positions, including bending and straightening your knees. This is to check your strength and ability to move.

To test nerve function, the doctor uses a rubber hammer to check your reflexes. To test how well your nerves sense feeling, the doctor touches your legs in many places with a pin, cotton swab, or feather.

A brain and nervous system (neurologic) examination helps confirm leg weakness and decreased sensation in the legs. The following tests may be done:

Treatment

Your doctor and other health professionals will help you manage your pain and keep you as active as possible.

Treatments for back pain caused by spinal stenosis include:

Spinal stenosis symptoms often become worse over time, but this may happen slowly. If the pain does not respond to these treatments, or you lose movement of feeling, you may need surgery.

Surgery may include removing a bulging disc, removing part of the vertebra bone, or widening the opening where your spinal nerves are.

After some spinal surgery, the surgeon may fuse some of the spine bones to make your spine more stable.

   

Outlook (Prognosis)

Many people with spinal stenosis are able to be active with the condition, although they may need to make some changes in their activities or work.

Spine surgery will often partly or fully relieve symptoms. It is hard to predict if you will improve and how much relief surgery will provide. 

Rarely, changes caused by pressure on the nerves may be permanent, even if the pressure is relieved.

When to Contact a Medical Professional

Call your health care provider if you have symptoms of spinal stenosis.

More serious symptoms that need prompt attention include:

References

Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008;358:794-810.

Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med. 2008;358:818-825.

Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis. Four-year results of the Spine Patient Outcomes Research Trial. Spine. 2010;35:1329-1338.

Chou R, Baisden J, Carragee Ej, Resnick DK, Shaffer WO, Loeser JD. Surgery for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009;34:1094-1109.

Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine. 2009;34:1078-1093.