Why Spinal Stenosis Happens
Spinal stenosis questionnaire
Use our free symptom checker to find out if you have spinal stenosis.
What is spinal stenosis?
Spinal stenosis is the narrowing of the spinal canal. Your spinal cord runs through this canal, transmitting signals back and forth between your brain and your body. When the canal becomes narrowed, largely due to normal wear-and-tear, it pushes on the nerves of the spinal cord, leading to irritation.
The inflammation and pressure on the spinal cord nerves cause pain, weakness, numbness, and tingling in the arms or legs. These symptoms are usually worse when you stand up or walk.
Spinal stenosis can happen at any spot in the spine, but most people experience “lumbar” spinal stenosis (in the lower back) or “cervical” spinal stenosis (by the neck).
Treatment ranges from exercise and physical therapy to surgery.
Most common symptoms
People with symptomatic lumbar spinal stenosis usually have limitations with their activity due to pain or weakness. They’re unable to do things that they regularly do, such as grocery shopping, walking for exercise, golfing, etc. It’s a frustrating condition and most people are interested in “getting back to their normal lives.” —Dr. Brian Walcott
Lumbar spinal stenosis leads to symptoms in both legs, including pain, weakness, numbness, and tingling. This pain is worse when standing or walking. It improves with bending, sitting, or laying down as these postures take pressure off of the spinal nerves.
Symptoms may get worse over time in some people, but not everyone.
Cervical spinal stenosis is a more serious type, affecting nerves in both the arms and legs, and leading to weakness of nearly the entire body. It also causes a greater loss of sensation in your arms and legs.
People typically have pain in their neck that spreads down the arms, pain in their legs, and weakness and numbness in the arms or legs. The symptoms often make it hard to walk.
Another illness, called peripheral vascular disease (narrowing of the arteries in the legs), can have similar symptoms in the legs, so it’s important to see your doctor.
- Pain in the legs—usually both sides in the thighs, calves, and feet.
- Pain gets worse when you stand up for a long time. Or when walking, especially downhill.
- Pain gets better when you bend over, sit, or lay down.
- Pain might be so bad that you stoop forward as you walk.
- Numbness or weakness in the legs.
- Lower back pain, sometimes.
Other symptoms you may have
- Incontinence of the bowels or bladder.
Additional symptoms of cervical spinal stenosis
- Numbness or tingling in the arms and hands.
- Loss of dexterity in the hands.
- Difficulty with balance.
Causes of spinal stenosis
Spinal stenosis can be seen on an MRI, but may not be the cause of symptoms such as low back pain. It is important to understand that low back pain is different from spinal stenosis. —Dr. Walcott
Spinal stenosis is almost always the result of normal wear-and-tear. As you age, you have more wear on the bones and discs of the spine. The discs become less spongy, which can cause them to bulge into the spinal canal.
Bone spurs may also occur, pushing into the canal. These factors cause a narrowing of the canal, which then presses on the nerves of the spinal cord.
Risk factors include:
- Having family members with the condition.
- Having rheumatoid arthritis or osteoarthritis.
- A prior traumatic injury of the spine.
- Cancer that may push on the spinal canal.
- Conditions from birth that affect the spine.
- Being obese.
If you have symptoms, make an appointment with your primary care doctor. They will do a physical exam and might order imaging tests like X-rays or an MRI of the spine. They are checking if your spinal canal has narrowed.
Your doctor will also do a few other tests to make sure you don’t have another, similar condition, such as peripheral vascular disease (narrowing of the arteries in the legs).
Go to the emergency room if you have low back pain and any of the following symptoms:
- Night sweats
- Trouble walking
- Unexplained weight loss
- Recent traumatic injury
- Symptoms that are rapidly getting worse
- Unable to control your bowels or bladder (fecal or urinary incontinence)
These are signs that you could have an infection, mass, or that something is dangerously compressing the nerves in the spinal cord.
What is the best treatment for spinal stenosis?
Spinal stenosis related to arthritis is very common. Almost everybody will have some degree of arthritis in their spine by age 50. Generally, non-surgical options are the preferred first-line treatment. —Dr. Walcott
Unlike other conditions, the symptoms of lumbar spinal stenosis usually don’t get worse over time. But the pain is often bad enough to interfere with day-to-day life.
Try to manage the pain and other symptoms with nonsurgical treatments like physical therapy. And over-the-counter pain relievers like acetaminophen (Tylenol) and ibuprofen (Advil, Motrin).
If the pain isn’t getting better, your doctor might inject steroids into your spine. Though these injections don’t always work.
If none of these treatments helps, you might need surgery.
Sometimes, people with spinal stenosis need surgery. There are several types for spinal stenosis. Talk to your surgeon about which is right for you. Most commonly, surgery helps reduce pressure on the spinal nerves. If the small bones that make up the spinal canal (called vertebrae) are unstable, your surgeon might fuse them during surgery.
- Lumbar laminectomy: Removes bone and ligament from the back part of the spine. This relieves pressure on the nerve roots.
- Cervical laminectomy: Removes bone and ligament from the back part of the cervical spine. This relieves pressure on the cervical spinal cord and nerve roots.
- Anterior cervical discectomy or disc replacement: Removes the disc between the bones of the spine. Surgery is done from the front of the neck. This allows for removal of ligament and disc that can press on the spinal cord and nerve roots.
- Spinal fusion: This allows bones of the spine to grow together into a single unit. Typically accomplished by placing bone chips, screws, and rods into the spine.
Most people who have surgery for spinal stenosis have significant improvement in their symptoms though some people do not. Also, in some cases, the pain comes back after a few years. Up to 1 in 5 people will need repeat surgery at some point. Discuss the benefits and drawbacks of surgery with your surgeon.
Most people are home from the hospital the same day or the next day. People can expect to have limited activity and no heavy lifting for 2 to 4 weeks. Usually, they are back to their normal routines in about 6 to 8 weeks.
What activities should be avoided with spinal stenosis?
If you have spinal stenosis, you want to stop any activity that could damage your spine more. This includes contact sports—football or martial arts—and high-impact activities like jogging.
Walking and swimming are safe, as long as the walking doesn’t cause pain. But standing for long periods of time can make it worse or anything that involves leaning backward like stretching your back or certain yoga poses.
Jesse Passman is a PGY-1 surgery resident. He graduated from Rice University with a BS in Ecology and Evolutionary Biology and received his MD from the University of Pennsylvania Perelman School of Medicine. During medical school, Jesse performed work in public health and surgery, taking a year-out to pursue an MPH at the University of Pennsylvania and do research in global surgery and the public health implications and clinical outcomes of trauma. In his free time, Jesse likes to travel, hike, backpack, and cycle.