Lumbar spinal stenosis: symptoms, causes and treatment options

Overview

Spinal stenosis means the space around the nerves in your spine has become narrow. In the lower back, this can squeeze the nerves that go to your legs. Many people notice leg pain, heaviness or tingling when they stand or walk. The pain often eases when they sit down or lean forward. Spinal stenosis is common as people get older. The good news is that there are many ways to manage it, and most people start with simple steps. Our physicians can help find out what is causing your pain and which options may help you.

Watch: Spinal Stenosis explained

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What it is

Your spine has a canal in the middle that holds the spinal cord and nerves. Over time, this canal can get smaller. Common reasons include:

• A ligament in the back of the spine (the ligamentum flavum) that gets thicker
• Arthritis in the small facet joints, sometimes with bone spurs
• A disc that bulges into the canal
• One bone slipping forward on another (spondylolisthesis)

When the narrowing presses on nerves, it can cause symptoms. Stenosis can also happen in the neck (cervical stenosis), but this page focuses on the lower back (lumbar stenosis).

Symptoms

Symptoms often build slowly. They may include:

• Pain, heaviness, cramping or tiredness in the legs or buttocks when you stand or walk
• Relief when you sit, bend forward or lean on something, like a shopping cart
• Numbness or tingling in the legs or feet
• Low back pain
• Being able to walk shorter distances than before

Some people have changes on an MRI but no symptoms at all. That is why your exam matters as much as your images.

Get urgent care (call 911 or go to the emergency room) if you have new or quickly worsening leg weakness, numbness in the groin or inner thighs, or loss of bladder or bowel control. These can be signs of a serious nerve problem.

How it is diagnosed, step by step

1. Talk and history. We ask when the pain started, what makes it better or worse, how far you can walk and what you have tried.
2. Physical exam. We check your strength, reflexes, feeling and how you walk.
3. Imaging. An X-ray, MRI or CT scan may show where and why the canal is narrow.
4. Other tests if needed. Nerve tests or a check of blood flow to the legs may help rule out other causes, since poor circulation can also cause leg pain with walking.
5. A plan together. We match your options to your symptoms, imaging and goals.

Treatment and what to expect

Care is usually step by step. Many people start with the simplest options and move on only if pain continues.

• Self-care and activity: short walks, a stationary bike or water exercise. Leaning-forward positions often feel easier.
• Physical therapy: exercises for core strength, flexibility and walking.
• Medicines: your clinician may suggest certain medicines for a short time.
• Epidural steroid injection: may calm nerve irritation and ease leg pain for some people.
• Minimally invasive procedures: for selected people, the mild® procedure (to remove part of a thickened ligament) or an interspinous spacer may be options.
• Spinal cord stimulation: may be considered for some people with ongoing pain.
• Surgery: a decompression surgery (such as a laminectomy) may be discussed when symptoms are severe, getting worse or causing weakness.

Stenosis often changes slowly. Some people stay the same for years, some get better and some get worse. Regular follow-up helps us adjust your plan.

Who may be a good fit for treatment

You may benefit from an evaluation if leg or back pain limits how far you can walk or stand, or if you have tried rest and home exercise without enough relief.

Some treatments are not right for everyone. For example, people with an active infection, a bleeding problem or certain spine conditions may need a different plan. Our physicians will review your health history, medicines and imaging before suggesting any procedure.

Risks in brief

Spinal stenosis itself can sometimes get worse over time and, rarely, cause lasting weakness or numbness. Each treatment has its own risks. Injections and procedures can cause soreness, bleeding, infection or, rarely, nerve injury. Surgery has larger risks and a longer recovery. We will go over the risks of any option with you before you decide.

Alternatives

There is no single right treatment. Depending on your situation, options may include watching and waiting, physical therapy, medicines, injections, minimally invasive procedures, spinal cord stimulation or surgery. You can also ask for a second opinion.

Frequently asked questions

Insurance

GSMC participates with all Aetna plans, including Aetna HMO, and with many other insurance plans. Coverage for a specific procedure depends on your plan and may need prior authorization; call 732-202-3000 to verify. Our team can help check your benefits before treatment.

See accepted insurance

Related pages

Related conditions

• Sciatica

Treatments and resources

• Epidural steroid injection
• MILD procedure
• Interspinous spacer (Vertiflex / Superion)
• Spinal cord stimulation