Spinal stenosis

Definition
Spinal stenosis is a narrowing of the lumbar (back) or cervical (neck) spinal canal, which causes compression of the nerve roots.

Causes, incidence, and risk factors
Spinal stenosis mainly affects middle-aged or elderly people. It may be caused by Osteoarthritis or Paget’s disease or by an injury that causes pressure on the nerve roots and/or the spinal cord itself.

Symptoms

     
  • Pain in the buttocks, thighs or calves that is worse with walking or exercise  
  • Numbness in the buttocks, thighs or calves, that is worse with standing, walking or exercise  
  • Back pain that radiates to the legs  
  • Weakness of the legs  
  • Neck pain  
  • Leg pain  
  • Difficulty or imbalance when walking

Signs and tests
An examination of reflexes of lower extremities reveals asymmetry. Neurologic examination confirms leg weakness and decreased sensation in the legs.

     
  • An X-ray of the spine shows degenerative changes and narrowed spinal canal.  
  • A spine MRI or spinal CT scan shows spinal stenosis.  
  • An EMG may show active and chronic neurological changes.

Treatment

Generally, conservative management is encouraged. This involves the use of anti-inflammatory medications, other pain relievers, and possibly steroid injections. If the pain is persistent and does not respond to these measures, surgery is considered to relieve the pressure on the nerves.

Surgery is performed on the neck or lower back, depending on the site of the nerve compression.

Expectations (prognosis)
If the nerve roots can be successfully relieved of pressure, the symptoms will not worsen and may improve.

Complications

Injury can occur to the legs or feet due to lack of sensation; infections may progress because pain related to them may not be felt. Changes caused by nerve compression may be permanent, even if the pressure is relieved.

Calling your health care provider
Call your health care provider if symptoms suggestive of spinal stenosis develop.

Johns Hopkins patient information

Last revised: December 7, 2012
by Mamikon Bozoyan, M.D.

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