An Overview of Spinal Stenosis

Pinching of the Spinal Cord Due to Narrowing of the Spinal Canal

Spinal Stenosis
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Your spinal canal runs through each vertebra (bones in your back) and contains and protects the spinal cord. When the spinal canal is narrowed—a condition called spinal stenosis—the spinal cord and/or nerve roots near it are compressed. This may lead to symptoms like pain and numbness of the hands, arms, legs, and/or feet (depending on the region where the compression is occurring).

The most common cause of spinal stenosis is "wear and tear arthritis" (called osteoarthritis). Bulging discs or less commonly, a tumor or an inflammatory or metabolic bone process, are the underlying culprits.

The diagnosis of spinal stenosis requires a comprehensive approach—one that involves a medical history, physical examination, and one or more imaging studies. While a small number of people may need surgery for their spinal stenosis, most people can be treated with simple strategies, such as physical therapy and medication.

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:

Keep in mind, there are a number of factors that may increase a person's risk of developing spinal stenosis.

Some of these risk factors include:

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

Symptoms

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.

People who have lumbar spinal stenosis may experience lower back pain, as well as pain, tingling, or weakness in one or both of their legs. These symptoms are often triggered when walking or standing up, and then subside after sitting down or leaning over.

People with cervical spinal stenosis may experience neck pain and stiffness, in addition to pain, weakness, or numbness in the hands, arms, and legs.

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

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 doctor, 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 doctor will check your reflexes, access for muscle weakness and sensory disturbances, and check your gait, balance, and pain level.

Imaging Studies

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

Here are the imaging studies commonly ordered for the workup of spinal stenosis:

  • X-ray of the spine: An X-ray can be useful for identifying the culprit behind a person's spinal stenosis—such as spinal tumors, traumatic injury, spinal arthritis, or inherited abnormalities.
  • Computed tomography (CT) scan of the spine: 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.
  • Magnetic Resonance Imaging (MRI) of the spine: An MRI 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.
  • Myelogram: A myelogram is like an X-ray, 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, like patients with cardiac pacemakers.

Blood and Other Tests

Bood and other tests may be ordered to help diagnose the cause behind the 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

Most cases of spinal stenosis are treated conservatively with medication and physical therapy. 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 technique is called decompression laminectomy, which entails removing the buildup of bone in the spinal canal. A spinal fusion surgey is often also performed along with this surgery.

Complementary Therapies

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

Some of these therapies may include:

A Word From Verywell

There is no cure for spinal stenosis, and it usually worsens over time. 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.

Lastly, 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.

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Article Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  3. Akhavan-Sigari R, Rohde V, Alaid A. Cervical Spinal Canal Stenosis and Central Disc Herniation C3/4 in a Man with Primary Complaint of Thigh Pain. J Neurol Surg Rep. 2013 Dec;74(2):101-4. doi:10.1055/s-0033-1349202

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Additional Reading

  • Klippel JH. Primer on the Rheumatic Diseases. New York, NY: Springer; 2008.

  • Levin K. (2018). Lumbar spinal stenosis: Pathophysiology, clinical features, and diagnosis. Aminoff ML, Atlas SJ, eds. UpToDate. Waltham, MA: UpToDate Inc.

  • The University of Michigan Medicine. (2018) Cervical Spinal Stenosis.