Topic Overview
Is this topic for you?
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.
What is lumbar 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.
What causes lumbar spinal stenosis?
It's most often caused by changes that can happen as people age. For example:
- Connective tissues called
ligaments get thicker.
- Arthritis leads to the growth of bony spurs that
push on the nerves that branch out from the spinal cord.
- Discs between the bones may be pushed
backward into the spinal canal.
What are the symptoms?
Symptoms may include:
- Numbness, weakness, cramping, or pain in the
legs, feet, or buttocks. These symptoms get worse when you walk, stand
straight, or lean backward. The pain gets better when you sit down or lean
forward.
- Stiffness in the legs and thighs.
- Low back
pain.
- In severe cases, loss of bladder and bowel control.
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.
How is lumbar spinal stenosis diagnosed?
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.
How is it treated?
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.
Frequently Asked Questions
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Learning about lumbar spinal stenosis:
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Being diagnosed:
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Getting treatment:
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Ongoing concerns:
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Living with lumbar spinal stenosis:
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Cause
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
discs and
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:
- An abnormally narrow spinal canal, which can
be an inherited condition.
- Spondylolysis,
which is a defect or fracture on one or both of the wing-shaped parts of a
vertebra. A vertebra may slide forward or backward over the bone below and may
squeeze the spinal cord or a nerve root.
- Spinal
fracture.
- Cancer.
- Fibrosis, which
is excess, ropy tissue much like scar tissue. It can come from having spine surgery in the
past.
Symptoms
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.
Leg pain
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
Other symptoms may
include:
- Numbness,
weakness, and cramping in the legs, feet, or
buttocks.
- Stiffness in the legs and
thighs.
- Low back pain.
- In severe cases, loss of bladder
and bowel control.
Several
other conditions have symptoms similar to spinal stenosis.
What Happens
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.
What Increases Your Risk
The risk of having lumbar
spinal stenosis increases if you:
- Are older than age 50.
- Have a
history of spinal injury.
- Have
arthritis of the spine, which
can damage
the
joints.
- Have a bone disease that may
soften the spinal bones or cause calcium deposits to form. Examples include:
- Are born
with spondylolysis.
- Have an abnormally narrow spinal canal, which
may be inherited or may develop in curvature of the spine (scoliosis).
- Have a
genetic (inherited) disorder in which the bones of the
arms and legs don't grow to normal size and the vertebrae of the spine don't
grow normally (achondroplastic dwarfism).
- Have had lower back
surgery, which may cause scarring that puts pressure on the spinal nerves.
Progressive spinal stenosis may occur, even after successful back
surgery.
When To Call a Doctor
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 now or seek immediate medical care if:
- Leg pain is accompanied by persistent weakness,
tingling, or numbness in any part of the leg from the buttock to the ankle or
foot.
- Low back pain is accompanied by vomiting,
fever, or both.
- Leg pain, weakness, numbness that
comes and goes (intermittent), or tingling lasts longer than 1 week even though you use home treatment.
- You lose control of your bladder or bowels.
- Significant back pain either does not improve
or gets worse over 2 weeks.
Watchful waiting
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.
Who to see
The following health professionals can diagnose and
treat spinal stenosis:
Specialists who can treat spinal stenosis include the
following:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
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:
- MRI, to check your spinal nerves and look for disc problems.
- CT scan, to check your bones and joints.
- X-rays, to
measure the extent of arthritis or injuries to the vertebrae.
- Bone scan,
to rule out cancer and other bone diseases.
- Electromyogram and nerve conduction tests to see if other problems may be causing or adding to your symptoms.
- Myelogram, to look for narrowing of the spinal
canal or abnormalities of the nerves branching off the canal. This is
rarely used to diagnose spinal stenosis.
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.
Treatment Overview
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.
Treatments include:
- Home treatment, such as exercising, using over-the-counter pain medicines, and losing extra weight.
- Prescription medicines to relieve pain.
- Physical therapy, to provide education, instruction, and support for your self-care.
- Surgery, although most cases don't need this treatment.
Prevention
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:
- Get regular exercise, including flexibility stretches.
- Stay at a healthy weight.
- Have good posture.
- Don't
smoke. Smoking has been linked to back pain and disc problems. It decreases your
bone density and increases your risk of fracture and bone deterioration. Also,
smoking can make it harder for the bone to heal after a spinal
fusion.
Home Treatment
You can take steps to treat lumbar spinal stenosis symptoms at home:
- Learn about stenosis and about how to relieve symptoms.
- Taking medicines, such as
nonsteroidal anti-inflammatory drugs (NSAIDs) or
acetaminophen, to relieve pain.
- Lose extra weight, which not only can relieve symptoms but also can slow progression of
the stenosis.
- Exercise. Aerobic exercise as well as stretching and
strengthening exercises for the lower back and stomach muscles can relieve
symptoms and improve muscle strength, especially when done 4 or 5 times a week.
The most helpful aerobic exercises include riding a stationary bike (with
the spine flexed in a forward position) and walking on a treadmill with an
incline.
- Restrict activities that make your symptoms worse.
Depending on the severity and location of your stenosis, these activities might
include walking (especially walking downhill) and standing for a length of
time.
Be sure to talk with your doctor before
you start home treatment.
Prevent falls
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:
- Limit your use of alcohol and
sedative medicines, including flurazepam (Dalmane) and
diazepam (such as Valium). They cause drowsiness and dizziness.
- Remove household hazards: slippery floors, poor lighting,
electrical cords, cluttered walkways, and throw rugs.
- Take medicines only as directed by your doctor. Review medicines
regularly with your primary care doctor, especially if you have more than
one doctor prescribing them. Medicines like sleeping pills and pain relievers may increase your risk for falling.
- Wear
low-heeled shoes that fit well.
Medications
Taking
medicine along with other nonsurgical treatment is often enough to
relieve pain and allow you to do normal daily activities.
Medicine choices
Medicines used to relieve the symptoms of spinal stenosis
include:
Surgery
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:
- Your pain, numbness, or
weakness is so bad that it gets in the way of normal daily activities and hurts your quality of
life.
- You are in otherwise good health.
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.
Lumbar Spinal Stenosis: Should I Have Surgery?
Surgery choices
Other Treatment
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.
Other Places To Get Help
Organizations
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North American Spine Society
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| 7075 Veterans Boulevard |
| Burr Ridge, IL 60527 |
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| Phone: |
(630) 230-3600
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| Fax: |
(630) 230-3700 |
| Web Address: |
www.spine.org |
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The North American Spine Society (NASS) promotes education, research, and advocacy for spine care. This group's patient education website (www.KnowYourBack.org) has information on the cause, treatment, and prevention of neck and back problems. It has references and brochures to help patients make health decisions. NASS members are spine care professionals such as orthopedic surgeons, neurosurgeons, neurologists, physiatrists, physical therapists, and researchers.
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RadiologyInfo |
| c/o Radiological Society of North America, Inc. |
| 820 Jorie Boulevard Oak Brook, IL 60523-2251 |
| Phone: |
(630) 571-2670
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| Fax: |
(630) 571-7837 |
| Web Address: |
www.radiologyinfo.org |
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RadiologyInfo is a joint project of the American College of Radiology and the Radiological Society of North America. The website is designed to answer consumer questions about radiology procedures and therapies. RadiologyInfo has information on X-ray, CT scan, MRI, ultrasound, and other procedures. The information includes how they are used for diagnosis and treatment, how to prepare for the procedures, and what a patient may experience.
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| American Academy of Orthopaedic Surgeons
(AAOS) |
| 6300 North River Road |
| Rosemont, IL 60018-4262 |
| Phone: |
1-800-346-AAOS (1-800-346-2267)
(847) 823-7186 |
| Fax: |
(847) 823-8125 |
| Email: |
orthoinfo@aaos.org |
| Web Address: |
www.orthoinfo.aaos.org |
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The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise.
|
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| American College of Rheumatology |
| 2200 Lake Boulevard NE |
| Atlanta, GA 30319 |
| Phone: |
(404) 633-3777 |
| Fax: |
(404) 633-1870 |
| Web Address: |
www.rheumatology.org |
| |
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The American College of Rheumatology (ACR) and the
Association of Rheumatology Health Professionals (ARHP, a division of ACR) are
professional organizations of rheumatologists and associated health
professionals who are dedicated to healing, preventing disability from, and
curing the many types of arthritis and related disabling and sometimes fatal
disorders of the joints, muscles, and bones. Members of the ACR are physicians;
members of the ARHP include research scientists, nurses, physical and
occupational therapists, psychologists, and social workers. Both the ACR and
the ARHP provide professional education for their members.
The ACR
website offers patient information fact sheets about rheumatic diseases, about
medicines used to treat rheumatic diseases, and about care
professionals.
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| Arthritis Foundation |
| P.O. Box 7669 |
| Atlanta, GA 30357 |
| Phone: |
1-800-283-7800 |
| Web Address: |
www.arthritis.org |
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The Arthritis Foundation provides grants to help find a
cure, prevention methods, and better treatment options for arthritis. It also
provides a large number of community-based services nationwide to make living
with arthritis easier, including self-help courses; water- and land-based
exercise classes; support groups; home study groups; instructional videotapes;
public forums; free educational brochures and booklets; the national, bimonthly
consumer magazine Arthritis Today; and continuing
education courses and publications for health professionals.
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| National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), National Institutes of Health |
| 1 AMS Circle |
| Bethesda, MD 20892-3675 |
| Phone: |
1-877-22-NIAMS (1-877-226-4267) toll-free |
| Phone: |
(301) 495-4484 |
| Fax: |
(301) 718-6366 |
| TDD: |
(301) 565-2966 |
| Email: |
niamsinfo@mail.nih.gov |
| Web Address: |
www.niams.nih.gov |
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The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
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References
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.
- Hu SS, et al. (2006). Stenosis of the lumbar spine
section of Disorders, diseases, and injuries of the spine. In HB Skinner, ed.,
Current Diagnosis and Treatment in Orthopedics, 4th ed.,
pp. 249–252. New York: McGraw-Hill.
- Isaac Z, Wang D (2008). Lumbar spinal stenosis. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 2nd ed., pp. 259–265. Philadelphia: Saunders Elsevier.
- 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.
- Weinstein JN, et al. (2007). Surgical versus
nonsurgical treatment for lumbar degenerative spondylolisthesis.
New England Journal of Medicine, 356(22):
2257–2270.
Credits
| By |
Healthwise Staff |
| Primary Medical Reviewer |
William H. Blahd, Jr., MD, FACEP - Emergency Medicine |
| Specialist Medical Reviewer |
Robert B. Keller, MD - Orthopedics |
| Last Revised |
February 13, 2012 |
