Spinal Stenosis

Spinal stenosis is a narrowing of the space inside the spine where the nerves and spinal cord travel. It is one of the most common reasons older adults develop back pain, leg pain, or trouble walking. Many patients improve with non-surgical care, and when surgery is needed, modern procedures can be very effective.

What’s happening

Your spinal cord and nerve roots run through a bony tunnel called the spinal canal, with smaller side openings (foramina) where each nerve exits. With age, the discs flatten, the small joints in the back of the spine enlarge with arthritis, and ligaments thicken. These changes narrow the space available for the nerves. When the nerves don’t have enough room, they become irritated — especially during standing and walking — and produce pain, numbness, or weakness in the legs.

Common symptoms

• Low back pain, often with leg pain that worsens with standing or walking
• Heaviness, cramping, or burning in the buttocks and legs that eases when you sit or lean forward (sometimes called the “shopping cart sign”)
• Numbness or tingling in the legs or feet
• Weakness in the legs or balance problems
• For cervical (neck) stenosis: hand clumsiness, trouble with buttons or handwriting, and trouble with balance

Causes & risk factors

The most common cause is gradual age-related arthritis of the spine. A smaller number of people are born with a naturally narrow canal (congenital stenosis) that becomes symptomatic earlier in life. Risk increases with age over 50, prior spine injury, scoliosis, rheumatoid or psoriatic arthritis, and smoking. Genetic factors also play a role.

How it’s diagnosed

Your provider will ask about how far you can walk before symptoms start and what positions relieve them. The physical exam tests strength, reflexes, sensation, and balance. MRI is the best imaging test — it shows the discs, joints, ligaments, and how much room the nerves have. X-rays show alignment, instability, or arthritis. CT myelography is reserved for patients who cannot have MRI.

Treatment options

Non-surgical care is the starting point. Many patients live well with lumbar stenosis without surgery. Standard measures include:

• Physical therapy focused on core strengthening, posture, and walking endurance
• Activity changes — using a walker or shopping cart, taking sitting breaks, walking uphill or on a treadmill at an incline
• Over-the-counter anti-inflammatory medication; short courses of nerve-pain medication when appropriate
• Epidural steroid injections to reduce nerve inflammation
• Weight loss and smoking cessation, which both improve spine health

Surgery is considered when symptoms significantly limit your daily life despite conservative care, when imaging clearly shows compression that matches your symptoms, or when there is progressive weakness or signs of spinal cord pressure (myelopathy). The standard operation for lumbar stenosis is a laminectomy or laminotomy — a procedure that removes a small portion of bone and ligament to open up space for the nerves. When the spine is also unstable or slipped (spondylolisthesis), a fusion may be added. For cervical stenosis with cord compression, an anterior or posterior decompression is performed, sometimes combined with fusion.

When to see a specialist

Schedule an evaluation if leg pain or walking limitation has not improved with several weeks of conservative care, if symptoms are getting worse, or if you are developing weakness or balance problems. Seek urgent care for new loss of bowel or bladder control, numbness in the groin, or rapid leg weakness.