Spinal Stenosis

What is spinal stenosis?

Spinal stenosis is the narrowing of one or more spaces within your spinal canal. Your spinal canal is the tunnel that runs through each of the vertebrae in your spine. It contains your spinal cord. Less space within your spinal canal cramps your spinal cord and the nerves that branch off it (nerve roots).

A tightened space can cause your spinal cord or nerves to become irritated, compressed or pinched. This can lead to back pain and other nerve issues, like sciatica. Several conditions and injuries can lead to a narrowed spinal canal.

Spinal stenosis can affect anyone, but it’s most common in people over the age of 50.

The condition most commonly affects two areas of your spine:

• Lower back (lumbar spinal stenosis): Your lumbar spine consists of five bones (vertebrae) in your lower back. Your lumbar vertebrae, known as L1 to L5, are the largest of your entire spine.
• Neck (cervical spinal stenosis): Your cervical spine consists of seven vertebrae in your neck. These vertebrae are labeled C1 to C7.

Your middle back (thoracic spine) can also have spinal stenosis, but this is rare.

How common is spinal stenosis?

Spinal stenosis is fairly common. Degenerative spinal changes affect up to 95% of people by the age of 50. Spinal stenosis is one of those changes. For people over 65 undergoing spine surgery, lumbar spinal stenosis is the most common diagnosis.

What are the symptoms of spinal stenosis?

Depending on where and how severe your spinal stenosis is, you might feel the following in your neck, back, arms, legs, hands or feet:

• Pain
• Numbness.
• Tingling.
• Weakness.

Spinal stenosis usually develops slowly over time. For this reason, you may not have any symptoms for a while, even if it shows up on X-rays or other imaging tests. Symptoms may come and go and affect each person differently.

Symptoms of lumbar spinal stenosis

Symptoms of lumbar (low back) spinal stenosis include:

• Pain in your low back.
• Pain that begins in your buttocks and extends down your leg. It may continue into your foot.
• A heavy feeling in your legs, which may lead to cramping in one or both legs.
• Numbness or tingling (“pins and needles”) in your buttocks, leg or foot.
• Pain that worsens when you stand for long periods of time, walk or walk downhill.
• Pain that lessens when you lean forward, walk uphill or sit.

Symptoms of cervical spinal stenosis

You can feel symptoms of cervical spinal stenosis anywhere below the point of the nerve compression in your neck. Symptoms include:

• Neck pain.
• Numbness or tingling in your arm, hand, leg or foot.
• Weakness or clumsiness in your arm, hand, leg or foot.
• Balance problems.
• Decreased function in your hands, like having issues writing or buttoning shirts.

What does spinal stenosis pain feel like?

Pain from spinal stenosis can feel different from person to person. Some describe it as a dull ache or tenderness. Others describe it as an electric-like or burning sensation. The pain can come and go.

What causes spinal stenosis?

Spinal stenosis has several causes. Many different changes or injuries in your spine can cause a narrowing of your spinal canal. The causes are split into two main groups:

• Acquired (developing after birth).
• Congenital (from birth).

Acquired spinal stenosis is more common. It usually happens from “wear and tear” changes that naturally occur in your spine as you age. Only 9% of cases result from congenital causes.

Acquired causes of spinal stenosis

Acquired spinal stenosis means you develop it later in life (after birth) — most commonly after the age of 50. These cases usually happen from an injury or changes in your spine that occur as you age (degenerative changes).

Causes of acquired spinal stenosis include:

• Bone overgrowth: Osteoarthritis is the “wear and tear” condition that breaks down the cartilage in your joints, including your spine. Cartilage is the protective covering of joints. As your cartilage wears away, your bones begin to rub against each other. Your body responds by growing new bone. Bone spurs, or an overgrowth of bone, commonly form. Bone spurs on your vertebrae extend into your spinal canal, narrowing the space and pinching nerves in your spine. Paget’s disease of the bone can also cause an overgrowth of bone in your spine.
• Bulging or herniated disks: Between each vertebra is a flat, round cushioning pad (vertebral disk) that acts as a shock absorber. As you age, the disks can dry out and flatten. Cracking in the outer edge of the disks can cause the gel-like center to break through. The bulging disk then presses on the nerves near the disk.
• Thickened ligaments: Ligaments are the fiber bands that hold your spine together. Arthritis can cause ligaments to thicken over time and bulge into your spinal canal.
• Spinal fractures and injuries: Broken or dislocated bones in your vertebrae or near your spine can narrow your canal space. Inflammation from injuries near your spine can also cause issues.
• Spinal cysts or tumors: Growths within your spinal cord or between your spinal cord and vertebrae can narrow your spinal canal.

Congenital causes of spinal stenosis

Congenital spinal stenosis affects babies and children. It can happen due to:

• Issues with spine formation during fetal development.
• Genetic (inherited) conditions that affect bone growth. These are due to genetic mutations (changes).

Some congenital causes of spinal stenosis include:

• Achondroplasia: A bone growth disorder that results in dwarfism due to a genetic mutation.
• Spinal dysraphism: When the spine, spinal cord or nerve roots don’t form properly during fetal development. Spina bifida and other neural tube defects are examples.
• Congenital kyphosis: When your child’s spine curves outward more than it should. As a result, their upper back looks overly rounded. This happens due to an issue with fetal spine development.
• Congenital short pedicles: When your baby is born with vertebrae pedicles (the bony “sides” of the spinal canal) that are shorter in length. This decreases their spinal canal size.
• Osteopetrosis: A rare genetic condition that causes your child’s bones to grow abnormally and become overly dense.
• Morquio syndrome: A rare genetic condition that affects your child’s bones, spine and other body systems.
• Hereditary multiple exostoses (diaphyseal aclasis): A rare genetic condition that causes several small bone growths (protrusions). They can grow on your child’s vertebrae and affect their spinal canal.

How is spinal stenosis diagnosed?

Your healthcare provider will review your medical history, ask about your symptoms and do a physical exam. Your provider may feel your spine, pressing on different areas to see if it causes pain. They’ll likely ask you to bend in different directions to see if certain spine positions bring on symptoms.

You’ll also have imaging tests so your provider can “see” your spine and determine the exact location, type and extent of the problem. These tests may include:

• Spine X-ray: X-rays use a small amount of radiation and can show changes in bone structure. For example, they can show a loss of disk height or bone spurs.
• MRI: Magnetic resonance imaging (MRI) uses radio waves and a powerful magnet to create cross-sectional images of your spine. MRI provides detailed images of your nerves, disks and spinal cord. It can reveal any tumors as well.
• CT scan or CT myelogram: A computed tomography (CT) scan is a combination of X-rays that creates cross-sectional images of your spine. A CT myelogram uses a contrast dye so your provider can more clearly see your spinal cord and nerves.

What is the treatment for spinal stenosis?

There are many treatment options for spinal stenosis. What’s best for you depends on:

• The cause.
• The location of the issue.
• The severity of your symptoms.

If your symptoms are mild, your healthcare provider may recommend at-home care first. If these methods don’t work and as symptoms worsen, your provider may recommend physical therapy, medications, injections and, finally, surgery.

At-home care for spinal stenosis

At-home care may include:

• Applying heat: Heat usually is the better choice for osteoarthritis pain. Heat increases blood flow, which relaxes your muscles and relieves aching joints. Be careful when using heat — a high heat setting can burn you.
• Applying cold: If heat isn’t easing your symptoms, try ice, like an ice pack, frozen gel pack or a frozen bag of peas. Apply the ice for 20 minutes on and 20 minutes off. Ice reduces swelling, tenderness and inflammation.
• Exercising: Check with your healthcare provider first, but exercise can help relieve pain. It also strengthens your muscles to support your spine and improves your flexibility and balance.

Nonsurgical treatment for spinal stenosis

Nonsurgical treatments mainly help manage symptoms of spinal stenosis. They include:

• Oral medications: Over-the-counter nonsteroidal anti-inflammatory medications (NSAIDs) can help relieve inflammation and provide pain relief from spinal stenosis. Be sure to talk with your provider to learn about the possible long-term problems of taking these medicines. Your provider may also recommend prescription medications with pain-relieving properties. These may include the antiseizure medication called gabapentin or tricyclic antidepressants, like amitriptyline. If you have muscle cramps or spasms, muscle relaxants may help.
• Physical therapy: Physical therapists will work with you to develop a back-healthy exercise program to help you gain strength and improve your balance, flexibility and spine stability. Strengthening your back and abdominal muscles (your core) will make your spine more resilient. Physical therapists can teach you how to walk in a way that opens up your spinal canal, which can help ease pressure on your nerves.
• Steroid injections: Getting corticosteroid injections in the space around pinched spinal nerves may help reduce inflammation, pain and irritation.

Surgery for spinal stenosis

Spinal stenosis is complex, and your spine is a delicate area. Because of this, providers consider surgery only if all other treatment options haven’t worked. Fortunately, most people who have spinal stenosis don’t need surgery.

Types of spine surgery include:

• Laminectomy (decompression surgery): This is the most common type of surgery for spinal stenosis. It involves removing the lamina, which is a portion of your vertebra. The surgeon may also remove some ligaments and bone spurs. The procedure makes more room for your spinal cord and nerves.
• Laminotomy: This is a partial laminectomy. The surgeon only removes a small part of the lamina — the area causing the most pressure on the nerve.
• Laminoplasty: This surgery is just for your neck (cervical spinal stenosis). The surgeon removes part of the lamina to provide more canal space. They use metal plates and screws to create a hinged bridge across the area where they removed bone.
• Foraminotomy: The foramen is the area in your vertebrae where the nerve roots exit. This procedure involves removing bone or tissue in this area to provide more space for the nerve roots.
• Interspinous process spacers: This is a minimally invasive surgery for some people with lumbar spinal stenosis. The surgeon inserts spacers between the bones that extend off the back of each vertebrae called the spinous processes. The spacers help keep your vertebrae apart, creating more space for nerves.
• Spinal fusion: Healthcare providers use spinal fusion as a last option. They only consider it if you have radiating nerve pain from spinal stenosis, your spine is not stable and other treatments haven’t helped. Spinal fusion surgery permanently joins (fuses) two vertebrae together.

Can I prevent spinal stenosis?

As most causes of spinal stenosis are normal age-related “wear and tear” conditions, you can’t totally prevent spinal stenosis. But you can take certain steps to keep your spine healthy. They may help lower your risk or slow the progression of spinal stenosis. These steps include:

• Eating healthy foods. Be sure you’re getting enough calcium in your diet to keep your bones strong.
• Maintaining a weight that’s healthy for you.
• Avoiding smoking or quitting smoking. Smoking damages your arteries, which can contribute to back pain and make it difficult for any injuries to heal.
• Practicing good posture.
• Exercising regularly. Keeping your muscles strong, especially your back and core muscles, helps to keep your spine healthy.

What is the prognosis for spinal stenosis?

The prognosis (outlook) for spinal stenosis varies based on several factors, like:

• Its location.
• Its severity.
• Your overall health.

In most cases, the prognosis for spinal stenosis is good. Many people with spinal stenosis can live full and active lives with nonsurgical treatment. But it’s important to remember that spinal stenosis affects each person differently, so not every treatment works for everyone.

What are the complications of spinal stenosis?

In severe cases, spinal stenosis can cause a loss of bladder or bowel control (incontinence). It can also cause sexual dysfunction due to nerve issues, like erectile dysfunction or anorgasmia.

It’s very rare, but extreme cases of spinal stenosis can cause partial or complete leg paralysis.

When should I see my healthcare provider about spinal stenosis?

If you notice new back pain or other symptoms, like tingling or weakness in your extremities, talk to a healthcare provider.

If you’re receiving treatment for spinal stenosis and it’s not working to help your symptoms, talk to your provider about other options.

A note from Cleveland Clinic

Back and neck pain can interrupt your daily life. The good news is that there are many treatment options for spinal stenosis. See your healthcare provider to discuss your options. They’re available to help.