What Is Spinal Stenosis?

Spinal stenosis is a narrowing of the spinal canal that causes compression of the spinal cord and/or nerve roots. Resulting pain and numbness (in the hands, arms, legs, and/or feet) can vary depending on the region where the compression is occurring. The most common cause of spinal stenosis is "wear and tear arthritis" (called osteoarthritis), though there are other possibilities, including bulging discs.

Spinal Stenosis Types and Symptoms

Your spinal canal runs through each vertebra and contains and protects the spinal cord and the lumbar nerve roots.

Spinal stenosis most commonly occurs in the lower back (called lumbar stenosis) and neck (called cervical stenosis).

 

Very rarely, the thoracic region (mid to upper back) of the spine is affected (called thoracic stenosis).

The most common symptoms of thoracic spinal stenosis include:

• Leg pain, numbness, and/or weakness
• Unsteady gait
• Low back pain

With severe cases of spinal stenosis, a person may experience impaired bladder, bowel, or sexual function, and even paralysis.

Causes

Spinal stenosis can be a congenital condition, with some people having a narrow spinal canal from birth. But more often, spinal stenosis is acquired, resulting from osteoarthritis of the spine.

Thickening of a ligament in the back and bulging discs may also cause spinal stenosis.

Other causes of spinal stenosis include trauma, tumors, and infections.

Factors that may increase a person's risk of developing spinal stenosis include:

• Being over the age of 50
• Being female
• A prior spinal injury or surgery on your spine
• Obesity (for lumbar stenosis)
• Cumulative trauma
• Cigarette smoking

Diagnosis

A multifaceted approach is often needed to diagnose spinal stenosis and includes a history, physical examination, and imaging studies.

History and Physical Examination

During your appointment with your healthcare provider, they will inquire about your specific symptoms, including their severity and duration.

A physical exam that focuses on your neck, back, and extremities will also be performed. Specifically, your healthcare provider will check your reflexes, assess for muscle weakness and sensory disturbances, and check your gait, balance, and pain level.

Imaging

Imaging studies are usually used to confirm a diagnosis of spinal stenosis and to help rule out alternative diagnoses.

The imaging studies commonly ordered for the workup of spinal stenosis include

• Magnetic resonance imaging (MRI): An MRI of the spine is the best test for diagnosing spinal stenosis. It can reveal the precise location of the stenosis and help pinpoint exactly what is placing pressure on the spinal cord and nerve roots.
• Computed tomography (CT): A CT scan is more sophisticated than an X-ray and can reveal areas of compression within the spinal canal, as well as bony growths from osteoarthritis (called bone spurs) and fractures.
• X-ray: An X-ray of the spine can be useful for identifying the culprit behind a person's spinal stenosis, such as a spinal tumor, traumatic injury, spinal arthritis, or an inherited abnormality.
• Myelogram: A myelogram is like a CT scan, but entails injecting dye into the cerebrospinal fluid surrounding the spinal cord and nerves. This test may be used in people who cannot undergo an MRI (e.g., patients with cardiac pacemakers).

Blood and Other Tests

Bood and other tests may be ordered to help diagnose certain causes of spinal stenosis (for example, Paget's disease) or rule out other potential diagnoses.

A test called an electromyography (EMG) may also be ordered in the diagnostic workup of spinal stenosis. This test measures how well the nerves that originate in your spine are functioning.

Treatment

There is no cure for spinal stenosis, and it usually worsens over time. Most cases of spinal stenosis are treated conservatively with medication and physical therapy, which can improve symptoms. In severe cases, surgery may be required.

Physical Therapy

If you are diagnosed with spinal stenosis, you may be referred to physical therapy. A physical therapist can give you exercises to perform that will help maintain and strengthen your muscles, especially in your arms and upper legs.

Regular exercise can also help ease your pain and improve spine mobility. If you aren't able to exercise due to the pain, you can start with flexion-based exercises and work up to walking or swimming for 30 minutes, three times per week.

Medication

Nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and cortisone injections are often used to help control the pain and inflammation of spinal stenosis.

Surgery

Surgery is a possibility when all else fails—although, most people with spinal stenosis do not require surgery.

There are different surgical techniques used to treat spinal stenosis. One such example is decompression laminectomy, which entails removing the buildup of bone in the spinal canal. A spinal fusion surgery is sometimes performed along with this procedure.

Complementary Therapies

While the scientific evidence backing up their benefit is scant, one or more complementary therapies (used under the guidance of your healthcare provider) may be incorporated into your treatment plan to help soothe pain from spinal stenosis.

Some of these therapies may include:

• Massage therapy
• Acupuncture
• Chiropractic care

A Word From Verywell

You cannot stop spinal stenosis from progressing. However, with the right treatment plan—one that includes a combination of regular exercise and medication—you can optimize your pain control and mobility and live well.

If you or a loved one is suffering from spinal stenosis, it's a good idea to obtain a consultation from someone who specializes in back disorders, such as a rheumatologist or physiatrist, so you can get guidance from an expert on your condition.