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This topic is about spinal stenosis of the lower back, also known as the lumbar area. If you need information on spinal stenosis of the neck, see the topic Cervical Spinal Stenosis.
Lumbar spinal stenosis is a narrowing of the spinal canal in the lower back, known as the lumbar area.
This usually happens when bone or tissue—or both—grow in the openings in the spinal bones. This growth can squeeze and irritate nerves that branch out from the spinal cord.
The result can be pain, numbness, or weakness, most often in the legs, feet, and buttocks.
It's most often caused by changes that can happen as people age. For example:
Symptoms may include:
Symptoms may be severe at times and not as bad at other times. Most people aren't severely disabled. In fact, many people don't have symptoms at all.
Your doctor can tell if you have it by asking questions about your symptoms and past health and by doing a physical exam.
You will probably need imaging tests such as an MRI, a CT scan, and sometimes X-rays.
You can most likely control mild to moderate symptoms with pain medicines, exercise, and physical therapy. Your doctor may also give you a spinal shot of corticosteroid, a medicine that reduces inflammation.
You may need surgery if your symptoms get worse or if they limit what you can do. Surgery to remove bone and tissue that are squeezing the nerve roots can help relieve leg pain and allow you to get back to normal activity. But it may not help back pain as much.
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The most common cause of lumbar spinal stenosis is changes in the spine that can happen as you get older.
These changes include thickening of soft tissues, development of bony spurs, and gradual breakdown of spinal discsand joints. Any of these conditions can narrow the spinal canal.
Spinal stenosis usually happens gradually. Symptoms may start when the changes begin to squeeze the spinal cord or its nerve roots.
These age-related changes often happen when you have certain disorders:
Also, other conditions may cause spinal stenosis, such as:
Many people, especially those older than age 50, have some narrowing of the spinal canal but don't have symptoms.
Symptoms occur when the nerve roots get squeezed.
The most common symptom is leg pain that happens when you walk or stand and feels better when you sit. You feel pain in your legs, because the nerve roots that pass through the lower spine extend to the legs.
People often have leg pain when the spine is extended—when they are standing straight or leaning backward, for example.
And they often feel better when the spine is flexed—when they are sitting, walking uphill, riding a bicycle, or leaning over a grocery cart, for example.
People with severe stenosis may have a habit of leaning forward in a stooped position to relieve pain.
Other symptoms may include:
Several other conditions have symptoms similar to spinal stenosis.
Lumbar spinal stenosis usually starts gradually and gets worse over a long period of time. Narrowing of the spinal canal can squeeze and irritate the nerve roots that branch out from the spinal cord. This is what causes pain and other symptoms.
Stenosis occurs most often in the lower back (lumbar) area. When it occurs in the neck, it is called cervical spinal stenosis.
The course of spinal stenosis varies—it may stay the same, get better, or get worse.
Severe disability isn't common. But when symptoms are very bad, they can keep you from doing your normal daily activities. They can have a big effect your quality of life. If symptoms are still severe after you have tried other treatment for a while, surgery may be considered.
Surgery may be too risky for some older adults who have other serious health problems.
The risk of having lumbar spinal stenosis increases if you:
Call 911 or other emergency services immediately if a person has signs of damage to the spine after an injury (such as a car accident, fall, or direct blow to the spine). Signs may include severe back pain, or weakness, tingling, or numbness in one or both legs.
Call your doctor nowif:
Lumbar spinal stenosis usually gets worse gradually over months to years. If you have symptoms that come on suddenly, you may have another serious condition and should call your doctor.
If you begin to regularly have leg pain when walking and standing, call your doctor.
The following health professionals can diagnose and treat spinal stenosis:
Specialists who can treat spinal stenosis include the following:
Lumbar spinal stenosis can usually be diagnosed based on your history of symptoms, a physical exam, and imaging tests—tests that produce various kinds of pictures of your body. These tests include:
Your doctor may try nonsurgical treatment, such as pain-relieving medicines, exercise, and physical therapy, for a period of time before ordering imaging tests. If treatment works, you may not need tests.
Imaging tests can help confirm a diagnosis or rule out other problems. But even if imaging shows spinal stenosis, your symptoms may not match the results of the tests. So treatment is based on what your symptoms are and how much spinal stenosis is impacting your life, not just on the results of imaging tests.
The goals of treatment for spinal stenosis are to relieve pain, numbness, and weakness in the legs, to make it easier for you to move around, and to improve your quality of life.
You can't always prevent changes in your back that may come with aging. But you may be able to limit spinal stenosis symptoms by keeping your back as healthy as possible:
You can take steps to treat lumbar spinal stenosis symptoms at home:
Be sure to talk with your doctor before you start home treatment.
Pain and numbness in your legs can increase your risk of losing your balance. Falling can make symptoms worse. Take steps to lower your risk of falling:
Taking medicine along with other nonsurgical treatment is often enough to relieve pain and allow you to do normal daily activities. Be safe with medicines. Read and follow all instructions on the label.
Medicines used to relieve the symptoms of spinal stenosis include:
Surgery is done to relieve pressure on the nerve roots. This can help reduce pain, numbness, and weakness in your legs.
Surgery may be recommended if:
The goal of surgery is to relieve pain, numbness, or weakness in the legs—not to relieve back pain. People who have surgery only for back pain are less satisfied with the results than are those who have surgery for nerve root symptoms and pain in both the back and legs. Also, numbness, weakness, and pain may return after surgery.
Decompressive laminectomy, which relieves pressure on the spinal nerve roots, is the most common procedure for relieving spinal stenosis. This surgery may be done with or without spinal fusion.
Physical therapy is an important treatment for spinal stenosis. It can help with pain and build muscle strength.
Your physical therapist may teach you exercises to strengthen your abdominal (belly) muscles, which will help support your spine. You may also learn exercises to help maintain flexibility and reduce inflammation.
Alternative and complementary medicine therapies, such as acupuncture, are used by some people to relieve pain from spinal stenosis.
Small metal devices can be inserted between the bones of the spine, near where the nerve roots leave the spinal cord. These are called interspinous process devices. The idea is to create more space between the bones, to take pressure off the nerve roots. This procedure may be an option for some people.
Other Works Consulted
American Academy of Orthopaedic Surgeons and American Academy of Pediatrics. (2010). Lumbar spinal stenosis. In JF Sarwark, ed., Essentials of Musculoskeletal Care, 4th ed., pp. 957–960. Rosemont, IL: American Academy of Orthopaedic Surgeons.
Atlas SJ, et al. (2005). Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10-year results from the Maine Lumbar Spine Study. Spine, 30(8): 927–935.
Chou R, et al. (2009). Interventional therapies, surgery and interdisciplinary rehabilitation for low back pain: An evidence-based clinical practice guideline from the American Pain Society. Spine, 34(10): 1066–1077.
Djurasovic M, et al. (2010). Contemporary management of symptomatic lumbar spinal stenosis. Orthopedic Clinics of North America, 41(2): 183–191.
Friedly JL, et al. (2014) A randomized trial of epidural glucocorticoid injections for spinal stenosis. New England Journal of Medicine, 371(1): 11–21. DOI: 10.1056/NEJMoa1313265. Accessed February 5, 2015.
Isaac Z, Lopez E (2015). Lumbar spinal stenosis. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 3rd ed., pp. 257–263. Philadelphia: Saunders.
Mercier LR (2008). Lumbar spine stenosis section of The back. In Practical Orthopedics, 6th ed., pp. 152–153. Philadelphia: Mosby Elsevier.
Resnick D, et al. (2005). Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine—Part 9: Fusion in patients with stenosis and spondylolisthesis. Journal of Neurosurgery, 2: 679–685.
Resnick DK, et al. (2005). Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine—Part 10: Fusion following decompression in patients with stenosis without spondylolisthesis. Journal of Neurosurgery, 2(6): 686–691.
Tay BKB, et al. (2014). Disorders, diseases, and injuries of the spine. In HB Skinner, PJ McMahon, eds., Current Diagnosis and Treatment in Orthopedics, 5th ed., pp. 156–229. New York: McGraw-Hill.
Weinstein JN, et al. (2007). Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. New England Journal of Medicine, 356(22): 2257–2270.
Current as ofSeptember 20, 2018
Author: Healthwise StaffMedical Review: William H. Blahd Jr. MD, FACEP - Emergency MedicineAdam Husney MD - Family MedicineE. Gregory Thompson MD - Internal MedicineKathleen Romito MD - Family MedicineKenneth J. Koval MD - Orthopedic Surgery, Orthopedic Trauma
Current as of:
September 20, 2018
Medical Review:William H. Blahd Jr. MD, FACEP - Emergency Medicine & Adam Husney MD - Family Medicine & E. Gregory Thompson MD - Internal Medicine & Kathleen Romito MD - Family Medicine & Kenneth J. Koval MD - Orthopedic Surgery, Orthopedic Trauma
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