Brief Overview: Spinal stenosis is a narrowing of the spinal canal, which puts pressure on the spinal cord and/or nerve roots. It most commonly occurs in the lumbar (lower back) and cervical (neck) regions. The condition can cause pain, numbness, weakness, and reduced mobility. Symptoms often develop gradually and may worsen over time.
Prevalence: According to Medscape, “Approximately 250,000-500,000 US residents have symptoms of spinal stenosis. This represents about 1 per 1000 persons older than 65 years and about 5 of every 1000 persons older than 50 years.”
Etiology:
- Age-related degenerative changes/spondylosis (most common)
- Osteoarthritis of the spine with bone spur formation
- Thickening of ligaments in the spine
- Herniated or bulging discs
- Congenital narrowing of the spinal canal
- Trauma or prior spinal surgery
- Intraspinal mass lesions
- Bone disease – Paget disease, RA, etc.
Risk Factors:
- Age > 50 years
- Physical labor involving heavy lifting
- Consumption of ultra-processed foods
- Previous spinal injury/surgery
- Genetics
- Obesity
Commonly Associated Conditions:
- Degenerative disc disease
- Spondylolisthesis
- Osteoarthritis
- Osteoporosis
- Peripheral neuropathy
Common Medications:
- Aspirin, NSAIDs, opiates
- Epidural injections
Common Labs, Imaging, and Tests:
- Spinal MRI – best test for spinal stenosis evaluation
- CT, myelography, x-ray
- Nerve conduction studies
Common Symptoms:
- Pain
- Numbness/tingling
- Weakness
- Neurogenic claudication — Neurogenic (or pseudo) claudication is a clinical hallmark of LSS [1]. This is the tendency for pain and/or sensorimotor dysfunction to be exacerbated with walking, standing, or maintaining certain postures with the lumbar spine extended, and relieved within minutes of sitting or lying down [28]. Neurogenic claudication is also often relieved when the lumbar spine is flexed, such as walking while leaning over a cart or leaning forward while riding a bicycle. Many patients with LSS are symptomatic only when active. (UpToDate)
- Weakness or clumsiness
- Balance difficulty
Common Treatments:
- Medication (see above)
- Physical therapy
- Surgery may be indicated for some
- Laminectomy
- Intraspinous spacer implantation
- Minimally invasive decompression
- Spinal fusion
Physical Findings:
- Neurological exam often normal
- Positive straight leg raise test may be present
- Focal weakness and/or sensory loss in distribution of one+ spinal nerve roots
- Gait impairment
Potential Complications and Contraindications:
- Cauda equina syndrome – neurological emergency
- Progressive weakness or paralysis
- Permanent nerve damage
- Medication-related risks: GI bleeding (NSAIDs), sedation (neuropathics, muscle relaxants)
- Surgical risks: Infection, blood clots, hardware failure, continued pain
General Health and Lifestyle Guidance:
- Maintain a healthy weight to reduce spinal pressure
- Engage in low-impact exercise (walking, swimming, cycling). Ask your healthcare provider what exercises are safe and recommended for you.
- Practice stretching and strengthening exercises for back and core. Ask your healthcare provider or physical therapist for recommendations.
- Use good posture and body mechanics when lifting
- Take frequent breaks when standing or walking long distances
- Use assistive devices (cane, walker) if balance is affected
Suggested Questions to Ask Patients:
- Where is your pain located, and what does it feel like?
- What activities make your pain worse or better?
- How far can you walk before needing to stop?
- Do you have numbness, tingling, or weakness in your arms or legs?
- Have you experienced any changes in bladder or bowel function?
- What treatments or medications have you tried so far?
- How does the pain affect your daily activities and quality of life?
Suggested Talking Points:
- Spinal stenosis is a common condition in older adults, and many people manage it well with a mix of lifestyle changes, therapy, and medication.
- If conservative treatments don’t help, there are minimally invasive and surgical options that may provide relief.
- Report immediately if you notice sudden weakness, difficulty walking, or changes in bladder/bowel control—these are urgent symptoms. Ask your healthcare provider for any other warning signs to watch for/report and advice on when you should seek urgent/emergency care.
- Staying active is one of the best ways to keep symptoms under control and maintain independence.
Sources:
- https://www.uptodate.com/contents/lumbar-spinal-stenosis-treatment-and-prognosis?search=spinal%20stenosis&source=search_result&selectedTitle=1~74&usage_type=default&display_rank=1
- https://www.uptodate.com/contents/lumbar-spinal-stenosis-pathophysiology-clinical-features-and-diagnosis?search=spinal%20stenosis&source=search_result&selectedTitle=2~93&usage_type=default&display_rank=2
- https://www.niams.nih.gov/health-topics/spinal-stenosis/diagnosis-treatment-and-steps-to-take
- https://my.clevelandclinic.org/health/diseases/17499-spinal-stenosis#symptoms-and-causes
- https://emedicine.medscape.com/article/1913265-overview#a6
This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.