What is Spinal Stenosis?

Spinal stenosis is narrowing of the spaces in the spine where the spinal cord and nerve roots travel. This narrowing can occur in the spinal canal, the neural foramina, or the lateral recesses, which are passageways where nerves move through and exit the spine.

Spinal stenosis can occur in the cervical spine in the neck, thoracic spine in the mid back, or lumbar spine in the lower back. Cervical spinal stenosis may affect the spinal cord or nerves in the neck. Lumbar spinal stenosis may affect the nerves traveling into the buttocks, legs, and feet. Thoracic spinal stenosis is less common but can affect the spinal cord in the mid back.

De Novo Brain & Spine evaluates adult patients with suspected or confirmed spinal stenosis when symptoms suggest nerve compression, spinal cord compression, cervical myelopathy, lumbar radiculopathy, sciatica, neurogenic claudication, spinal instability, or another structural spine condition that may require neurosurgical review.

Common Signs and Symptoms

Spinal stenosis symptoms depend on where the narrowing occurs, how severe it is, and whether the spinal cord or nerve roots are affected.

Common signs and symptoms may include:

• Neck pain, mid back pain, or low back pain
• Pain that travels into the shoulder, arm, hand, buttock, leg, or foot
• Numbness or tingling in the arms, hands, legs, or feet
• Weakness in the arms, hands, legs, ankles, or feet
• Sciatica, meaning radiating leg pain along the sciatic nerve pathway
• Neurogenic claudication, meaning leg pain, heaviness, cramping, or weakness that worsens with standing or walking
• Symptoms that improve when sitting or bending forward, especially in lumbar spinal stenosis
• Difficulty standing or walking for long periods
• Balance problems or trouble walking
• Hand clumsiness, dropping objects, or trouble buttoning clothing when cervical spinal cord compression is present
• Reduced grip strength when cervical nerve compression is present
• Foot drop or difficulty lifting the front of the foot in selected lumbar nerve compression cases
• Bowel, bladder, or sexual function changes in severe cases

Seek urgent medical evaluation for progressive weakness, foot drop, worsening numbness, balance problems, trouble walking, loss of hand coordination, numbness in the groin or saddle area, new bowel or bladder problems, severe pain after trauma, fever, unexplained weight loss, history of cancer, or rapidly worsening neurological symptoms. Seek emergency medical care or call 911 for symptoms concerning for cauda equina syndrome, spinal cord compression, stroke, or another emergency condition.

What Causes This Condition?

Spinal stenosis occurs when the spaces around the spinal cord or nerve roots become narrowed. This narrowing may develop gradually from degenerative spine changes or less commonly from trauma, tumor, infection, or other structural conditions.

Possible causes and related factors may include:

• Degenerative disc disease, which can reduce disc height and narrow nerve spaces
• Bulging disc or herniated disc
• Facet joint disease or arthritis of the small joints in the back of the spine
• Bone spurs, also called osteophytes
• Thickened ligaments, including thickening of the ligamentum flavum
• Spondylosis, meaning degenerative arthritis of the spine
• Spondylolisthesis, when one vertebra slips forward relative to another
• Foraminal stenosis, which is narrowing where a nerve exits the spine
• Central canal stenosis, which is narrowing around the spinal cord or nerve bundle
• Lateral recess stenosis, which is narrowing along the path of a nerve root before it exits the spine
• Spinal instability in selected cases
• Scoliosis or kyphosis, which may change spinal alignment and nerve space
• Vertebral compression fracture or traumatic spinal fracture
• Prior spine surgery or adjacent segment degeneration in selected patients
• Congenital spinal canal narrowing, meaning a person is born with a smaller spinal canal
• Spinal tumor, infection, cyst, or inflammatory disease in less common cases

These causes and risk factors do not mean every patient with spinal stenosis will have symptoms. Treatment planning depends on symptoms, neurological examination, imaging findings, severity of narrowing, spinal stability, response to prior care, and overall health.

How It Is Diagnosed?

Spinal stenosis is diagnosed by combining the patient’s symptoms, physical examination, neurological examination, and imaging findings. Imaging is important, but stenosis seen on MRI or CT must be matched with the patient’s symptoms and exam.

Common diagnostic steps may include:

• Medical history and symptom review to understand neck pain, back pain, arm pain, leg pain, numbness, tingling, weakness, walking tolerance, balance problems, injury history, and prior treatment
• Physical examination to evaluate posture, range of motion, tenderness, muscle spasm, walking pattern, and painful movement
• Neurological examination to assess strength, sensation, reflexes, coordination, gait, balance, hand function, and signs of nerve root or spinal cord involvement
• X-rays of the spine to evaluate alignment, arthritis, disc space narrowing, spondylolisthesis, instability, fracture, or degenerative change
• Flexion-extension X-rays in selected cases when abnormal motion or spinal instability is suspected
• MRI of the cervical, thoracic, or lumbar spine to evaluate spinal canal narrowing, foraminal stenosis, lateral recess stenosis, nerve root compression, spinal cord compression, disc disease, tumor, infection, or other soft-tissue findings
• CT scan when bone detail, fracture, arthritis, deformity, or surgical planning requires further evaluation
• CT myelogram in selected cases when MRI is not possible or when additional detail around the spinal canal and nerve roots is needed
• Electromyography and nerve conduction studies, also called EMG/NCS, when symptoms may overlap with radiculopathy, peripheral neuropathy, carpal tunnel syndrome, ulnar neuropathy, or peroneal neuropathy
• Blood tests in selected cases when infection, inflammatory disease, cancer-related concern, or another medical condition is suspected
• Diagnostic injections in selected cases when symptoms may overlap with facet joint disease, sacroiliac joint pain, or nerve root irritation

The goal of diagnosis is to identify where the narrowing is located, determine whether the spinal cord or nerve roots are compressed, and decide whether conservative care, injections, or surgical evaluation may be appropriate.

Treatment Options

Spinal stenosis treatment depends on the location of narrowing, severity of symptoms, neurological examination, imaging findings, spinal stability, prior treatment, walking tolerance, activity limitations, and overall health. Many patients begin with non-surgical care when there is no progressive neurological deficit, cauda equina syndrome, severe spinal cord compression, fracture, infection, tumor, or other urgent concern.

Treatment options may include:

• Activity modification to reduce positions, walking distance, lifting, extension, or movements that worsen symptoms
• Physical therapy to improve posture, flexibility, core strength, walking mechanics, balance, and spine stability
• Home exercise and stretching when recommended by a clinician or therapist
• Posture strategies, such as flexion-based positioning in selected lumbar stenosis cases
• Heat, ice, or other comfort measures for short-term symptom relief
• Anti-inflammatory medication, acetaminophen, muscle relaxants, or nerve pain medication when medically appropriate
• Treatment of posture, ergonomic, conditioning, or activity-related contributors
• Lumbar or cervical epidural steroid injection in selected cases involving nerve root inflammation or radiating arm or leg pain
• Selective nerve root block in selected cases when diagnostic or therapeutic nerve-targeted injection is appropriate
• Facet joint injection, medial branch block, or radiofrequency ablation in selected cases when facet joint pain overlaps with stenosis-related symptoms
• Lumbar decompression, such as laminectomy, laminotomy, or foraminotomy, in selected cases involving lumbar spinal stenosis or nerve root compression
• Cervical laminectomy or posterior cervical decompression in selected cases involving cervical spinal stenosis or spinal cord compression
• Anterior cervical discectomy and fusion, also called ACDF, in selected cervical cases involving disc-related stenosis, nerve compression, spinal cord compression, or instability
• Cervical posterior fusion when stabilization is needed for instability, deformity, trauma, or selected degenerative conditions
• Lumbar fusion, such as transforaminal lumbar interbody fusion, lateral interbody fusion, or anterior lumbar interbody fusion, in selected cases involving stenosis with instability, deformity, spondylolisthesis, or certain recurrent spine conditions
• Minimally invasive spine surgery in selected patients when anatomy, symptoms, and surgical goals support a less invasive approach
• Rehabilitation and follow-up care to monitor pain, strength, sensation, walking, balance, function, and neurological status

Surgery is not appropriate for every patient with spinal stenosis. Neurosurgical treatment may be considered when stenosis causes significant nerve compression, spinal cord compression, progressive weakness, foot drop, cervical myelopathy, cauda equina symptoms, severe walking limitation, or symptoms that do not improve with appropriate non-surgical care.