Is this topic for
This topic is about spinal stenosis of the lower back, also known
as the lumbar area. If you need information on spinal stenosis of the neck, see
the topic Cervical Spinal
What is lumbar spinal stenosis?
Lumbar spinal stenosis is a
narrowing of the
spinal canal in the lower
back, known as the lumbar area.
This usually happens when bone or
tissue—or both—grow in the openings in the spinal bones. This growth can
squeeze and irritate nerves that branch out from the
spinal cord .
result can be pain, numbness, or weakness, most often in the legs, feet, and
What causes lumbar spinal
It's most often caused by changes that can happen as people
age. For example:
- Connective tissues called
- Arthritis leads to the growth of bony
spurs that push on the nerves that branch out from the spinal cord.
- Discs between the bones may be pushed backward into the spinal
What are the
Symptoms may include:
- Numbness, weakness,
cramping, or pain in the legs, feet, or buttocks. These symptoms get worse when
you walk, stand straight, or lean backward. The pain gets better when you sit
down or lean forward.
- Stiffness in the legs and thighs.
- In severe cases, loss of bladder and bowel
Symptoms may be severe at times and not as bad at other
times. Most people aren't severely disabled. In fact, many people don't have
symptoms at all.
How is lumbar spinal
Your doctor can tell if you have it by asking
questions about your symptoms and past health and by doing a physical exam.
You will probably need imaging tests such as an
CT scan, and sometimes
How is it treated?
You can most likely control mild
to moderate symptoms with pain medicines, exercise, and
physical therapy. Your
doctor may also give you a spinal shot of corticosteroid, a medicine that reduces
You may need surgery if your symptoms get worse or if they
limit what you can do. Surgery to remove bone and tissue that are squeezing the
nerve roots can help relieve leg pain and allow you to get back to normal
activity. But it may not help back pain as much.
Frequently Asked Questions
Learning about lumbar spinal stenosis:
- What is lumbar spinal
- What causes it?
- What are the
- Can I prevent it?
- What happens when I have
- What increases my risk for
lumbar spinal stenosis?
- How common is it?
- Who can
diagnose lumbar spinal stenosis?
- How is it
- How is lumbar spinal stenosis
- Will I need surgery?
medicines will I need to take?
- What other treatments might be
- How will I know if it's
- Should I have
with lumbar spinal stenosis:
- What can I
do at home to feel better?
- When should I call my
Health Tools help you make wise health decisions or take action to improve your health.
Decision Points focus on key medical care decisions that are important to many health problems.
- Lumbar Spinal Stenosis: Should I Have Surgery?
The most common cause of lumbar spinal stenosis is
changes in the spine that can happen as you get older.
include thickening of soft tissues, development of bony spurs, and gradual
breakdown of spinal discs
and joints. Any of these
conditions can narrow the spinal canal.
Spinal stenosis usually happens
gradually. Symptoms may start when the changes begin to squeeze
the spinal cord or its nerve
These age-related changes often happen when you
have certain disorders:
- Arthritis of the spine wears away
joint cartilage and causes
bony growths (spurs).
- Certain bone diseases, such as
Paget's disease and
may soften the spinal bones or cause too much bone to grow.
other conditions may cause spinal stenosis, such as:
- An abnormally
narrow spinal canal, which can be an inherited condition.
- Spondylolysis, which is
a defect or fracture on one or both of the wing-shaped parts of a vertebra. A
vertebra may slide forward or backward over the bone below and may squeeze the
spinal cord or a nerve root.
- Fibrosis, which is excess, ropy tissue much like scar
tissue. It can come from having spine surgery in the
Many people, especially those older than age 50, have some narrowing of the
spinal canal but don't have symptoms.
Symptoms occur when the nerve
roots get squeezed.
The most common
symptom is leg pain that happens when you walk or stand and feels better when
you sit. You feel pain in your legs, because the
nerve roots that pass through the lower
spine extend to the legs.
People often have leg pain when
the spine is extended—when they are standing straight or leaning backward, for
And they often feel better when the spine is flexed—when they
are sitting, walking uphill, riding a bicycle, or leaning over a grocery cart,
People with severe stenosis may have a habit of leaning
forward in a stooped position to relieve
symptoms may include:
weakness, and cramping in
the legs, feet, or buttocks.
- Stiffness in the legs and thighs.
- Low back pain.
- In severe cases, loss of bladder and bowel
conditions have symptoms similar to spinal stenosis.
spinal stenosis usually starts gradually and gets worse over a long period of
time. Narrowing of the spinal canal can squeeze and irritate the
nerve roots that branch
out from the spinal cord. This is what causes pain and other symptoms.
Stenosis occurs most often in the lower back (lumbar) area. When it
occurs in the neck , it is
called cervical spinal
The course of spinal stenosis varies—it may stay
the same, get better, or get worse.
Severe disability isn't common. But
when symptoms are very bad, they can keep you from doing your normal daily
activities. They can have a big effect your quality of life. If symptoms are
still severe after you have tried other treatment for a while, surgery may be
Surgery may be too risky for some older adults who have
other serious health problems.
The risk of having lumbar spinal stenosis increases if you:
older than age 50.
- Have a history of spinal injury.
arthritis of the spine,
which can damage the joints.
- Have a bone disease
that may soften the spinal bones or cause calcium deposits to form. Examples
- Ankylosing spondylitis.
- Are born with spondylolysis.
- Have an
abnormally narrow spinal canal, which may be inherited or may develop in
curvature of the spine (scoliosis).
- Have a
disorder in which the bones of the arms and legs don't grow to normal size and
the vertebrae of the spine don't grow normally (achondroplastic dwarfism).
- Have had lower back surgery, which may cause scarring that puts pressure on
the spinal nerves. Progressive spinal stenosis may occur, even after successful
Call 911 or other emergency services
immediately if a person has signs of damage to the spine after an injury
(such as a car accident, fall, or direct blow to the spine). Signs may include
severe back pain, or weakness, tingling, or numbness in one or both legs.
Call your doctor now if:
- You have a new loss
of bowel or bladder control.
- Leg pain is accompanied by persistent weakness, tingling, or numbness in
any part of the leg from the buttock to the ankle or foot.
- Low back
pain is accompanied by vomiting, fever, or both.
- Leg pain, weakness,
numbness that comes and goes (intermittent), or tingling lasts longer than 1
week even though you use home treatment.
- Significant back pain either
does not improve or gets worse over 2 weeks.
spinal stenosis usually gets worse gradually over months to years. If you have
symptoms that come on suddenly, you may have another serious condition and
should call your doctor.
If you begin to regularly have leg pain when
walking and standing, call your doctor.
Who to see
The following health
professionals can diagnose and treat spinal stenosis:
- Family medicine physician
- Nurse practitioner
- Emergency medicine (ER) doctor
Specialists who can treat spinal stenosis include the following:
surgeon, including surgeons who specialize in the spine
- Neurologist or
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Lumbar spinal stenosis can usually be
diagnosed based on your history of symptoms, a
physical exam, and
imaging tests—tests that produce various kinds of pictures of your body. These
- MRI, to check your spinal nerves and
look for disc problems.
scan, to check your bones and joints.
- X-rays, to measure the extent of
arthritis or injuries to the vertebrae.
- Bone scan, to rule out cancer and other
and nerve conduction tests to see if other problems may be
causing or adding to your symptoms.
- Myelogram, to look for narrowing of the
spinal canal or abnormalities of the nerves branching off the canal. This is
rarely used to diagnose spinal stenosis.
Your doctor may try
nonsurgical treatment, such as pain-relieving medicines, exercise, and physical
therapy, for a period of time before ordering imaging tests. If treatment
works, you may not need tests.
Imaging tests can help confirm a
diagnosis or rule out other problems. But even if imaging shows spinal
stenosis, your symptoms may not match the results of the tests. So treatment is
based on what your symptoms are and how much spinal stenosis is impacting your
life, not just on the results of imaging tests.
The goals of treatment for spinal stenosis are to relieve pain, numbness,
and weakness in the legs,
to make it easier for you to move around, and to improve your quality of
- Home treatment, such as exercising,
using over-the-counter pain medicines, and losing extra weight.
- Prescription medicines to relieve pain.
- Physical therapy, to provide education,
instruction, and support for your self-care.
- Surgery, although most
cases don't need this treatment.
can't always prevent changes in your back that may come with aging. But you may
be able to limit spinal stenosis symptoms by keeping your back as healthy as
- Get regular exercise, including flexibility
- Stay at a healthy weight.
- Have good posture.
- Don't smoke. Smoking has been linked to back pain and disc problems. It
decreases your bone density and increases your risk of fracture and bone
deterioration. Also, smoking can make it harder for the bone to heal after a
You can take steps to treat lumbar spinal
stenosis symptoms at home:
- Learn about stenosis and about
how to relieve symptoms.
- Taking medicines, such as
drugs (NSAIDs) or acetaminophen, to relieve pain. Be safe
with medicines. Read and follow all instructions on the label.
extra weight, which not only can relieve symptoms but also can slow
progression of the stenosis.
- Exercise. Aerobic exercise as
well as stretching and strengthening exercises for the lower back and stomach
muscles can relieve symptoms and improve muscle strength, especially when done
4 or 5 times a week. The most helpful aerobic exercises include riding a
stationary bike (with the spine flexed in a forward position) and walking on a
treadmill with an incline.
- Restrict activities that make your
symptoms worse. Depending on the severity and location of your stenosis, these
activities might include walking (especially walking downhill) and standing for
a length of time.
Be sure to talk with your doctor before you
start home treatment.
numbness in your legs can increase your risk of losing your balance. Falling
can make symptoms worse. Take steps to lower your risk of falling:
- Limit your use of alcohol and sedative medicines, including
flurazepam (Dalmane) and diazepam (such as Valium). They cause drowsiness and
- Remove household hazards: slippery floors, poor lighting,
electrical cords, cluttered walkways, and throw rugs.
- Take medicines
only as directed by your doctor. Review medicines regularly with your primary
care doctor, especially if you have more than one doctor prescribing them.
Medicines like sleeping pills and pain relievers may increase your risk for
- Wear low-heeled shoes that fit
Taking medicine along with other nonsurgical treatment is often enough to
relieve pain and allow you to do normal daily activities. Be safe with
medicines. Read and follow all instructions on the label.
Medicines used to
relieve the symptoms of spinal stenosis include:
- Acetaminophen, which may relieve pain
but doesn't reduce inflammation.
- Nonsteroidal anti-inflammatory
(NSAIDs), such as naproxen and ibuprofen. They may relieve pain and reduce
- Opiate pain
relievers, to relieve severe pain that does not respond to other
medicines. Opiates are usually used only for short periods of time, to help
avoid side effects.
steroid injections (ESIs). These are sometimes tried to help leg
pain by reducing inflammation in the nerve root.
Surgery is done to relieve pressure on the
nerve roots. This can
help reduce pain, numbness, and weakness in your legs.
Surgery may be
- Your pain, numbness, or weakness is so bad that it
gets in the way of normal daily activities and hurts your quality of life.
- You are in otherwise good health.
The goal of surgery is to
relieve pain, numbness, or weakness in the legs—not to relieve back pain.
People who have surgery only for back pain are less satisfied with the results
than are those who have surgery for nerve root symptoms and pain in both the
back and legs. Also, numbness, weakness, and pain may return after surgery.
- Lumbar Spinal Stenosis: Should I Have
Decompressive laminectomy, which
relieves pressure on the spinal nerve roots, is the most common procedure for
relieving spinal stenosis. This surgery may be done with or without
Physical therapy is an important
treatment for spinal stenosis. It can help with pain and build muscle strength.
therapist may teach you exercises to strengthen your abdominal
(belly) muscles, which will help support your spine. You may also learn
exercises to help maintain flexibility and reduce
Alternative and complementary medicine therapies, such as
acupuncture, are used by
some people to relieve pain from spinal stenosis.
Small metal devices can
be inserted between the bones of the spine, near where the nerve roots leave
the spinal cord. These are called interspinous process devices. The idea is to
create more space between the bones, to take pressure off the nerve roots. This
procedure may be an option for some
North American Spine Society
American Academy of Orthopaedic Surgeons : OrthoInfo www.orthoinfo.aaos.org
- Low Back Pain
- Lumbar Herniated Disc
- Neck Pain
Other Works Consulted
American Academy of Orthopaedic Surgeons and American Academy of Pediatrics. (2010). Lumbar spinal stenosis. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 957–960. Rosemont, IL: American Academy of Orthopaedic Surgeons.
Atlas SJ, et al. (2005). Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10-year results from the Maine Lumbar Spine Study. Spine, 30(8): 927–935.
Chou R, et al. (2009). Interventional therapies, surgery and interdisciplinary rehabilitation for low back pain: An evidence-based clinical practice guideline from the American Pain Society. Spine, 34(10): 1066–1077.
Djurasovic M, et al. (2010). Contemporary management of symptomatic lumbar spinal stenosis. Orthopedic Clinics of North America, 41(2): 183–191.
Friedly JL, et al. (2014) A randomized trial of epidural glucocorticoid injections for spinal stenosis. New England Journal of Medicine, 371(1): 11–21. DOI: 10.1056/NEJMoa1313265. Accessed February 5, 2015.
Isaac Z, Lopez E (2015). Lumbar spinal
stenosis. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 3rd ed., pp. 257–263. Philadelphia: Saunders.
Mercier LR (2008). Lumbar spine stenosis section of The back. In Practical Orthopedics, 6th ed., pp. 152–153. Philadelphia: Mosby Elsevier.
Resnick D, et al. (2005). Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine—Part 9: Fusion in patients with stenosis and spondylolisthesis. Journal of Neurosurgery, 2: 679–685.
Resnick DK, et al. (2005). Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine—Part 10: Fusion following decompression in patients with stenosis without spondylolisthesis. Journal of Neurosurgery, 2(6): 686–691.
Tay BKB, et al. (2014). Disorders, diseases, and injuries of the spine. In HB Skinner, PJ McMahon, eds., Current Diagnosis and Treatment in Orthopedics, 5th ed., pp. 156–229. New York: McGraw-Hill.
Weinstein JN, et al. (2007). Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. New England Journal of Medicine, 356(22): 2257–2270.