Is this topic for you?
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 Stenosis.
What is lumbar spinal stenosis?
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 .
The result can be pain, numbness, or weakness, most often in the legs, feet, and buttocks.
What causes lumbar spinal stenosis?
It's most often caused by changes that can happen as people age. For example:
- Connective tissues called
ligaments get thicker.
- 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 canal.
What are the symptoms?
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
- Stiffness in the legs and thighs.
- Low back
- In severe cases, loss of bladder and bowel control.
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 stenosis diagnosed?
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 stenosis?
- What causes it?
- What are the symptoms?
- Can I prevent it?
- What happens when I have it?
- What increases my risk for lumbar spinal stenosis?
- How common is it?
- Who can diagnose lumbar spinal stenosis?
- How is it diagnosed?
- How is lumbar spinal stenosis treated?
- Will I need surgery?
- What medicines will I need to take?
- What other treatments might be recommended?
- How will I know if it's getting worse?
- Should I have surgery?
Living with lumbar spinal stenosis:
- What can I do at home to feel better?
- When should I call my doctor?
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.
These changes include thickening of soft tissues, development of bony spurs, and gradual breakdown of
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 roots .
These age-related changes often happen when you have certain disorders:
of the spine wears away joint
cartilage and causes bony growths
- Certain bone diseases, such as Paget's disease and ankylosing spondylitis, may soften
the spinal bones or cause too much bone to grow.
Also, other conditions may cause spinal stenosis, such as:
- An abnormally narrow spinal canal, which can
be an inherited condition.
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 occur when the nerve roots get squeezed.
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 example.
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, for example.
People with severe stenosis
may have a habit of leaning forward in a stooped position to relieve
Other symptoms may
weakness, and cramping in the legs, feet, or
- Stiffness in the legs and
- Low back pain.
- In severe cases, loss of bladder
and bowel control.
other conditions have symptoms similar to spinal stenosis.
Lumbar 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 stenosis.
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 considered.
may be too risky for some older adults who have other serious health
The risk of having lumbar
spinal stenosis increases if you:
- Are older than age 50.
- Have a
history of spinal injury.
arthritis of the spine, which
- Have a bone disease that may
soften the spinal bones or cause calcium deposits to form. Examples include:
- Paget's disease.
- Ankylosing spondylitis.
- Are born
- Have an abnormally narrow spinal canal, which
may be inherited or may develop in curvature of the spine (scoliosis).
- Have a
genetic (inherited) 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 back
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 or seek immediate medical care if:
- Leg pain is accompanied by persistent weakness,
tingling, or numbness in any part of the leg from the buttock to the ankle or
- 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.
- You lose control of your bladder or bowels.
- 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.
you begin to regularly have leg pain when walking and standing, call your
Who to see
The following health professionals can diagnose and
treat spinal stenosis:
- Family medicine physician
- Nurse practitioner
- Physician assistant
- Emergency medicine (ER) doctor
Specialists who can treat spinal stenosis include the
- Orthopedist/orthopedic surgeon,
including surgeons who specialize in the spine
- Neurologist or
- Physical therapist
To prepare for your appointment, see the topic Making the Most of Your Appointment.
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 tests include:
- MRI, to check your spinal nerves and look for disc problems.
- CT 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 bone diseases.
- Electromyogram 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.
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 life.
- 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.
You 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 possible:
- Get regular exercise, including flexibility stretches.
- Stay at a healthy weight.
- Have good posture.
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 spinal
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
nonsteroidal anti-inflammatory drugs (NSAIDs) or
acetaminophen, to relieve pain.
- Lose extra weight, which not only can relieve symptoms but also can slow progression of
- 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
- 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
Be sure to talk with your doctor before
you start home treatment.
Pain and numbness in your legs can increase your risk of losing your balance. Falling can make symptoms worse. Take steps to lower your risk of
- Limit your use of alcohol and
sedative medicines, including flurazepam (Dalmane) and
diazepam (such as Valium). They cause drowsiness and dizziness.
- 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 falling.
low-heeled shoes that fit well.
medicine along with other nonsurgical treatment is often enough to
relieve pain and allow you to do normal daily activities.
Medicines used to relieve the symptoms of spinal stenosis
- Acetaminophen, which may relieve pain
but doesn't reduce inflammation.
- Nonsteroidal anti-inflammatory drugs
(NSAIDs), such as naproxen and ibuprofen. They may relieve pain and
- 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.
- Epidural 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 recommended if:
- Your pain, numbness, or
weakness is so bad that it gets in the way of normal daily activities and hurts your quality of
- 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
- Lumbar Spinal Stenosis: Should I Have Surgery?
- Decompressive laminectomy, which relieves pressure on
the spinal nerve roots. This surgery may be done with or without spinal fusion.
Physical therapy is
an important treatment for
spinal stenosis. It can help with pain and build muscle strength.
physical 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.
North American Spine Society
|Web Address: ||www.spine.org|
|Web Address: ||www.radiologyinfo.org|
|American Academy of Orthopaedic Surgeons : OrthoInfo|
|Web Address: ||www.orthoinfo.aaos.org|
|American College of Rheumatology|
|Web Address: ||www.rheumatology.org|
|Arthritis Foundation (U.S.)|
|Web Address: ||www.arthritis.org|
|NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases (U.S.)|
|TDD: ||(301) 565-2966|
|Web Address: ||www.niams.nih.gov|
- 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
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.
Hu SS, et al. (2006). Stenosis of the lumbar spine
section of Disorders, diseases, and injuries of the spine. In HB Skinner, ed.,
Current Diagnosis and Treatment in Orthopedics, 4th ed.,
pp. 249–252. New York: McGraw-Hill.
Isaac Z, Wang D (2008). Lumbar spinal stenosis. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 2nd ed., pp. 259–265. Philadelphia: Saunders Elsevier.
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):
Weinstein JN, et al. (2007). Surgical versus
nonsurgical treatment for lumbar degenerative spondylolisthesis.
New England Journal of Medicine, 356(22):
|By: ||Healthwise Staff ||Current as of: March 12, 2014|
|Medical Review: ||William H. Blahd, Jr., MD, FACEP - Emergency Medicine|
Robert B. Keller, MD - Orthopedics