Spinal stenosis (or narrowing) is a common condition that occurs when the small spinal canal, which contains the nerve roots and spinal cord, becomes compressed. This causes a “pinching” of the spinal cord and/or nerve roots, which leads to pain, cramping, weakness or numbness. Depending on where the narrowing takes place, you may feel these symptoms in the lower back and legs, neck, shoulder or arms.
Usually, the narrowing is caused by osteoarthritis, or “wear and tear” arthritis, of the spinal column and discs between the vertebrae (the bones of the back). It may also be caused by a thickening of the ligaments in the back, as well as by a bulging of the discs that separate the vertebrae. Symptoms of spinal stenosis often start slowly and get worse over time. Pain in the legs may become so severe that walking even short distances is unbearable. Frequently, sufferers must sit or lean forward over a grocery cart, countertop or walker to temporarily ease pain.
Spinal stenosis is a narrowing of one or more areas of the spine through which nerves pass through. This narrowing, which occurs most often in the lower back or neck, can put pressure on the spinal cord or nerves that branch out from the squeezed areas. Typically, a person with this condition complains of severe pain in the legs, calves or lower back when standing or walking. Pain may come on more quickly when walking up or down a hill, a ramp or steps. Usually, it is relieved by sitting down or leaning over.
However, not all patients with spinal narrowing develop symptoms - and we still don’t understand why. Because of this, the term “spinal stenosis” actually refers to the symptoms of pain and not to the narrowing itself.
Some people are born with a small spinal canal. This is called “congenital stenosis”. However, spinal narrowing is most often due to age-related changes that take place over time. This is called “acquired spinal stenosis.”
The risk of developing spinal stenosis increases if:
Some medical conditions can cause spinal stenosis. These include:
A rheumatologist will ask about your symptoms and medical history. If he suspects spinal stenosis, he will do a physical exam. Some symptoms he will look for include:
A rheumatologist will also consider other conditions that can cause similar symptoms, such as arthritis of the hips or knees; disorders of the nervous system; or disorders of the heart and blood vessels. A rheumatologist may also order other tests to confirm the diagnosis and determine the seriousness of your condition. These include:
Although there is no cure for spinal stenosis, regular exercise, medication and in some cases, surgery can provide relief.
Regular exercise can help you build and maintain strength in the muscles of your arms and upper legs (the hip adductors and abductors, quadriceps and hamstrings). This will improve your balance, ability to walk, bend and move about, as well as control pain. A physical therapist can show you which exercises are right for you.
Over-the-counter medications such as acetaminophen (Tylenol), or nonsteroidal anti-inflammatories (commonly called NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Anaprox), may also relieve pain. In addition, a rheumatologist may prescribe other medications to help with pain and/or muscle spasm.
Cortisone injections (corticosteroid injections)
Injections directly into the area around the spinal cord (known as epidural injections) may provide a great deal of temporary and occasional permanent relief. There is little objective data however to support use of cortisone injections for spinal stenosis and many studies include other causes for back pain. These injections are usually given on an outpatient basis in a hospital or clinic setting.
Some patients with severe or worsening symptoms (but who are otherwise healthy) may be candidates for a “decompression laminectomy.” This surgery removes the bony spurs and buildup of bone in the spinal canal, freeing space for the nerves and spinal cord. Afterwards, doctors often perform a spinal fusion to connect two or more vertebrae and better support for the spine.
Several recent studies have found that surgery produces better results than non-surgical treatment in the short term. However, results vary and, like all surgeries, this one also carries risks. Some of these risks include blood clots in the brain and/or the legs; tears in the tissue around the spinal cord; infection; and injury to the nerve root. While surgery may bring some relief, it will not cure spinal stenosis or osteoarthritis and symptoms may recur.
Spinal stenosis can lead to the slow but steady loss of strength in the legs. The severe pain caused by this condition can be quite disabling, even if you have no muscle weakness, since it greatly affects your ability to work and enjoy life. The natural course of the disease is one of slow progression over time. There is no cure for this condition but there are steps you can take to feel better. For example:
Spinal stenosis can seriously disrupt a person’s life. The rheumatologist is often the one who makes the diagnosis and rules out other forms of rheumatic diseases. He or she will also help patients create a treatment strategy, which may include medications, exercise and physical therapy, or referral for surgical consultation.
Updated December 2021 by the American College of Rheumatology Committee on Communications and Marketing.
This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.