Spinal stenosis

Spinal stenosis is a narrowing of the spaces in the spine that hold the spinal cord and nerves. It usually develops gradually from age-related changes such as disc wear, joint arthritis, and thickened ligaments. It most often affects the lower back (lumbar stenosis) and the neck (cervical stenosis).

In the lower back:

• Pain, heaviness, cramping, numbness, or tingling in the buttocks and legs when standing or walking
• Relief with sitting or bending forward, such as leaning on a shopping cart
• Lower back pain

In the neck:

• Neck pain, with numbness, tingling, or weakness in the arms or hands
• Clumsiness with fine hand tasks, such as buttoning
• Problems with balance or walking

Diagnosis is based on symptoms, an examination, and imaging, typically X-rays and an MRI.

Non-operative treatment includes physical therapy focused on flexibility, core strength, and walking tolerance, activity changes, medications, and, for some people, image-guided epidural steroid injections.

Surgery may be considered when symptoms significantly limit walking or daily life despite non-operative care, or when compression of the nerves or spinal cord causes weakness or balance problems. Decompression surgery, such as a laminectomy, creates more room for the nerves; a fusion may be added when the spine is unstable. In the neck, surgery may be recommended sooner when the spinal cord itself is compressed.