Key takeaways
- Spinal stenosis is a narrowing of the space around the spinal nerves, most often in the lower back.
- The classic sign is leg pain, heaviness or numbness that builds with walking and eases with sitting or bending forward.
- A narrow canal on an MRI doesn't always mean it's the cause of your pain. A thorough exam is what connects the two.
- Many people improve with a well-designed non-surgical plan, especially when care starts early.
Helen was a 65-year-old nurse who had always been active. She played tennis and walked three miles twice a week. Then, over about a year, her legs began to ache. She cut back on her walks, then on shopping trips, then on housework. Eventually numbness crept into her legs and feet. An MRI showed spinal stenosis, and physical therapy and injections only helped for a short time.
Helen's story is typical of the patients we see. Most arrive with a diagnosis, have tried a few treatments that helped only briefly, and are watching their world get smaller. The good news is that there is usually more that can be done.
What is spinal stenosis?
Your spinal canal is the tunnel, formed by your vertebrae, that protects the spinal cord and the nerves running to your legs. Spinal stenosis means that space has narrowed. When it narrows enough, the nerves get crowded and irritated.
The size of your canal is partly genetic, but it usually narrows with age as the spine wears. That's why stenosis is most common after 50, and most often found in the lowest levels of the lower back (L3 to S1).
What causes it?
- Disc changes - discs that thin, bulge or herniate into the canal
- Thickened ligaments - the ligament inside the canal (the ligamentum flavum) can thicken and take up room
- Arthritis of the facet joints - bone spurs from the small joints at the back of the spine
- Posture and alignment - curves and misalignment that pinch the space further
- Scar tissue - from earlier injuries or spine surgery
What are the symptoms?
The hallmark is called neurogenic claudication: pain, aching, burning, heaviness or numbness in the buttocks or legs that builds as you stand or walk, and eases when you sit, lean forward or bring your knees to your chest. Leaning on a shopping cart often helps, because bending forward opens the canal slightly.
Symptoms often affect both legs, usually one more than the other. Many people find they can only walk a few blocks before they have to stop and rest. In more advanced cases the pain can become constant.
Could it be something else?
Yes. Several conditions can look like stenosis, and each needs a different treatment:
- A herniated disc without stenosis
- A torn or degenerated disc
- Spondylolisthesis (one vertebra slipping forward on another)
- Piriformis syndrome and other causes of sciatica
- A nerve pinched outside the spinal canal
- Poor circulation in the legs (vascular claudication), which needs a medical work-up
This is why imaging alone isn't enough. Plenty of people have a narrow canal on an MRI and few symptoms. A thorough examination is what tells us whether the stenosis is actually the source of your pain.
What are the treatment options?
Patients are often told there's nothing to be done for stenosis. That usually isn't true. Common options include:
- Medication - anti-inflammatories can ease symptoms for a while but don't change the narrowing.
- Injections - epidural injections can calm a flare, but relief is often temporary.
- Exercise - essential, but it has to be the right exercise. Movements that bend the spine forward (flexion) usually help; repeated arching backward often makes stenosis worse.
- Chiropractic care - can help when the techniques are chosen to open the canal, not compress it.
- Non-surgical spinal decompression - gentle, computer-controlled decompression such as the DRX9000, combined with alignment work and exercise.
- Surgery - sometimes necessary, for example with severe or progressive nerve damage. For most people it should come after careful non-surgical care has been tried.
Our approach
We start with a thorough evaluation. On your first visit we take your history and do a detailed exam and testing. Dr. Le then reviews your imaging, and on your second visit he walks you through the findings, the diagnosis and a plan. If stenosis is the problem and you're a good fit for non-surgical care, the plan usually combines decompression, hands-on care and a specific exercise program. If you're not a good fit, we'll tell you, and help you find the right specialist.
Stenosis rarely stays the same; it tends to progress with age, and nerves that have been compressed for a long time recover more slowly. If walking and standing are getting harder, it's worth getting a clear answer sooner rather than later.