What Is Spinal Stenosis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Spinal stenosis — also called vertebral stenosis — is a condition in which spaces in your spine become too narrow (the term “stenosis” refers to narrowing of any passage in the body). As a result, bones or other parts of the spine start pressing on your spinal cord and other nerves.

Although some people don’t experience symptoms, those who do may have pain, numbness, muscle weakness, and tingling in the neck or back.

Most people who get spinal stenosis are over age 50. Younger people may develop it if they have certain diseases, get injured, or are born with a narrower-than-usual spine. (1)

Spinal stenosis can happen anywhere along your spine, and its causes and symptoms may be different depending on where the narrowing occurs. Stenosis usually occurs in the cervical region of the spine near the head and neck, or in the lumbar region in the lower back.

Symptoms of spinal stenosis in the lower back may include:

• Lower back pain
• Pain or aching that spreads down your back into your legs; it feels worse when standing or walking and better when you lean forward
• Cramping, numbness, or tingling in your feet and legs
• Muscle weakness in the feet and legs.

Symptoms of spinal stenosis in the neck may include:

• Neck pain
• Tingling or numbness in your arms and hands
• Weakness in your arms and hands (2).

Age-related changes to the spine are the main cause of spinal stenosis. Aging bones and ligaments of your spine may gradually get thicker and stiffer, leaving less space between them. Bone spurs that press on the spine and nerves may also develop.

Here are some other risk factors for developing spinal stenosis:

• Osteoarthritis, which involves loss of cartilage in the joints, can trigger excessive bone growth, called bone spurs, that shrinks spinal spaces.
• Rheumatoid arthritis, which causes inflammation and enlargement of soft joint tissues, may also leave less room for the spine and nerves.
• Paget’s disease, which causes excessive bone growth, can affect the spine and result in stenosis.
• Injuries such as herniated disks can also lead to spinal stenosis. And car accidents or other traumatic injuries may leave vertebrae misaligned, leaving less space for nerves.
• Spinal tumors or abnormal growths may press on the spinal cord or nerves, leading to symptoms of stenosis. But this is uncommon. (1)

To determine if you have spinal stenosis, your doctor will ask about your symptoms and do a complete physical exam in which they look for signs of spinal stenosis, such as numbness and weakness.

It may also be necessary for your doctor to order one of the following tests to confirm the diagnosis:

• X-Ray An X-ray of your back can show bone changes that may be narrowing the spaces in the spinal canal.
• Magnetic Resonance Imaging (MRI) An MRI creates a cross-sectional image of your spine that can detect where nerves in the spinal cord are under pressure. It can also reveal any damage to disks and ligaments.
• Computed Tomography (CT) Scan If you can’t get an MRI, a CT scan can also create images of your spine. It combines X-ray images taken at different angles to produce a cross-sectional picture of your spine. (1)

Unfortunately, there isn’t a cure for spinal stenosis. The symptoms tend to start slowly and worsen over time. The good news is there are steps you can take to manage spinal stenosis such as exercising regularly and taking over-the-counter pain relievers. (3)

In rare cases, severe spinal stenosis that’s left untreated can progress and cause permanent weakness, numbness, balance problems, paralysis, and incontinence. (1)

Treatment of spinal stenosis depends on the severity of your symptoms. At-home treatments like stretching and massage therapy can help if your symptoms are mild. If your symptoms are severe, your doctor may recommend medication, physical therapy, or surgery (as a last resort).

Medication Options

• Ibuprofen (Advil or Motrin) and other nonsteroidal anti-inflammatory drugs (NSAIDs) can offer short-term relief.
• Antidepressants, such as tricyclic antidepressants, can help ease chronic pain.
• Anti-seizure drugs such as gabapentin (Neurontin) and pregabalin (Lyrica) can decrease pain from damaged nerves.
• Opioids such as oxycodone and hydrocodone may be used for short-term pain relief; however, they are used cautiously since they may become habit-forming.

Steroid injections can also help with the pain (though they don’t cure spinal stenosis). Getting too many steroid injections can weaken bones and connective tissue, so your doctor will likely limit them to a few times a year.

Non-Medication Treatments

There are a variety of nonpharmaceutical approaches that, in conjunction with medication, may help ease spinal stenosis symptoms.

• Physical Therapy Your doctor may recommend physical therapy, especially if you’ve become less active due to the pain caused by spinal stenosis. Weak muscles can actually lead to more pain. Working with a physical therapist can help you build strength, become more flexible, and improve your balance. For those with severely limited movement, aquatic physical therapy may be a good option.
• Hot or Cold Packs Ice packs or hot packs applied to the neck may ease symptoms of stenosis in the cervical region (around the neck). They can also be used on the lower back.
• Weight Loss Losing weight may help ease symptoms of lumbar (lower back) stenosis by reducing the load your spine has to bear. (1)

Complementary and Integrative Therapies

• Chiropractic Treatment Working with a chiropractor may provide some pain relief.
• Acupuncture Fine needles are used to stimulate specific locations on the body, which may reduce pain.

Prevention of Spinal Stenosis

Unfortunately, there’s no way to prevent spinal stenosis since most people will have some osteoarthritis in their spine by age 50. That said, there are ways to reduce your risk and keep your spine healthy:

• Exercise Regularly. Aerobic exercises such as walking, swimming, and cycling can help strengthen your back muscles and help keep your spine flexible.
• Protect Your Spine. Maintain good posture by sitting in a supportive chair and sleeping on a firm mattress. Avoid lifting heavy objects, or learn how to lift heavy objects safely.
• Maintain a Healthy Weight. Being overweight puts excess stress on your back and can cause spinal stenosis. (4)

Spinal stenosis, when severe, can lead to trouble walking due to numbness or weakness, as well as loss of bowel or bladder control. When these complications happen, talk to your doctor as surgery might be the best option.

Four kinds of surgery are commonly used to treat spinal stenosis:

Laminectomy In this procedure, a surgeon removes a sizable part of one or more vertebrae to give nerves more room. This may require fusing vertebrae together, or implanting hardware to strengthen the spine.

Laminotomy In this case, a surgeon removes a smaller portion of a vertebra to relieve some of the pressure.

Laminoplasty This procedure involves attaching a metal hinge to part of a vertebra. It is only performed on the neck.

Minimally Invasive Surgery This technique avoids spinal fusions and results in a quicker recovery time. (1)

Lumbar spinal stenosis affects more than 200,000 Americans. (5)

Although spinal stenosis is commonly seen on imaging, many do not report significant symptoms. One study — which used computed tomography (CT) scans to look for evidence of stenosis — found more than one in three participants (out of over 3,500) had some degree of stenosis in the lower back.

Among participants between ages 60 and 69, about two in three had stenosis. Among those under age 40, the rate was less than one in four. Most of the participants had relatively mild stenosis, and importantly, many had no accompanying symptoms, such as lower back pain. (6)

The prevalence of spinal stenosis does not differ by race or ethnicity; however, studies show that African Americans have poorer outcomes after spinal surgery.

According to one study, Black patients were 8 percent more likely than white patients to experience spinal fusion surgery complications and 14 percent more likely than white patients to have post-surgery complications. Black patients were also more likely to need longer hospital stays (resulting in higher hospital charges) and were more likely to require 30- and 90-day hospital readmissions.

For the study, researchers looked at discharge records of nearly 268,000 patients — almost 78 percent were white and 6.5 percent were Black. The findings are similar to previous studies that have shown how racial disparities impact outcomes after spinal surgery. (7)

Lumbar spinal stenosis can lead to cauda equina syndrome (CES), a very rare and serious issue where the cauda equina (a bundle of nerves attached to the bottom of the spine) is compressed and interrupts motor and sensory function in your lower body, including your bladder.

CES is usually caused by a large herniated disc in the lumbar regions, and it can cause loss of bowel or bladder control, sexual problems, and loss of feeling in the legs. (8)

As noted above, the following conditions increase your risk of developing spinal stenosis:

• Osteoarthritis
• Rheumatoid arthritis
• Paget’s disease

Mayo Clinic

In addition to providing clear, concise information on the symptoms, diagnosis, and treatment of spinal stenosis, the Mayo Clinic also offers advice on how best to prepare for an appointment with your doctor if you’re experiencing the kind of pain and numbness that could be due to this condition.

National Institute of Arthritis and Musculoskeletal and Skin Diseases

This division of the National Institutes of Health offers an up-to-date review on spinal stenosis, as well as details about any clinical trials that may be available.

The American Chronic Pain Association

The ACPA is dedicated to raising awareness about and support and connection for those living with chronic pain conditions, including spinal stenosis. On its website, you can search for a support group near you.