Spinal Stenosis

Spinal stenosis is a condition in which the open spaces in the spine become narrowed. This puts pressure on the spinal cord and/or nerves that travel into the arms or legs. It is one of the most common spine conditions in adults over 50, but it can occur earlier due to injury or structural changes. Most people can manage symptoms and maintain an active lifestyle with proper treatment.

What Causes Spinal Stenosis?

Spinal stenosis develops when age-related structural changes or other conditions reduce the space inside the spinal canal. Common causes and risk factors include:

• Arthritis/bone spurs
• Herniated discs
• Degenerative disc disease
• Thickened ligaments in the spine
• Spondylolisthesis
• Congenital spinal narrowing (present from birth)
• Spinal injuries or fractures

It most often affects the lumbar spine (lower back) and cervical spine (neck).

What Are the Symptoms?

Symptoms depend on the location of the narrowing:

• Lumbar spinal stenosis (lower back)
  • Lower back pain
  • Sciatica (sharp pain radiating into one or both legs)
  • Numbness, tingling, or weakness in the legs or feet
  • Cramping or heaviness in the legs when walking or standing, especially when relieved by sitting or bending forward
• Cervical spinal stenosis (neck)
  • Neck pain and stiffness
  • Tingling, numbness, or weakness in the arms or hands
  • Problems with balance or coordination
  • In severe cases, bladder or bowel dysfunction

When Should I See a Specialist About Spinal Stenosis?

You should see a spine specialist if you experience:

• Pain, numbness, or tingling in the back, neck, arms, or legs
• Difficulty walking or standing for long periods
• Weakness that interferes with daily activities
• Loss of balance or coordination

If you experience a loss of bladder or bowel control, you should seek emergency medical attention immediately.

Prompt care can prevent worsening nerve damage and improve recovery.

How Is Spinal Stenosis Diagnosed?

To diagnose spinal stenosis, a spine or orthopedic specialist will:

• Review your medical history and symptoms
• Perform a physical exam to check strength, reflexes, sensation, and walking ability
• Order imaging tests such as X-rays, MRI, or CT scans to confirm narrowing and nerve compression

How Is Spinal Stenosis Treated?

Treatment depends on the severity of symptoms and how much they impact daily life, as well as the location of the spinal stenosis. Many patients improve with nonsurgical care, while others require surgical interventions.

Nonsurgical Treatments

• Anti-inflammatory medications to reduce pain and swelling
• Physical therapy to improve flexibility, strength, and posture
• Steroid injections to relieve nerve inflammation
• Activity modification to avoid positions and movements that worsen symptoms

Surgical Treatments

Surgery may be considered if:

• Symptoms persist despite months of nonsurgical treatment
• Nerve or spinal cord compression causes weakness or significant disability
• Walking or standing becomes increasingly difficult

Common surgical procedures for spinal stenosis include:

• Laminectomy (decompression surgery): Removing part of the vertebra to relieve pressure on nerves
• Laminotomy or foraminotomy: Enlarging spaces where nerves exit the spine
• Decompression and spinal fusion: Stabilizing the spine if instability is present
• Disc replacements to preserve motion in select patients

These procedures can be performed through an open or minimally invasive approach

What Are the Risks of Spinal Stenosis Surgery?

While usually safe, surgery may involve risks such as:

• Infection
• Nerve injury (rare)
• Blood clots
• Spinal fluid leaks
• Spinal instability
• Persistent pain or stiffness

Working with an experienced spine surgeon and sticking to your rehabilitation plan can reduce these risks.

What Does Recovery From Surgery Involve?

Recovery may include:

• Short-term rest followed by gradual activity
• Physical therapy to restore mobility and strengthen muscles
• Avoiding heavy lifting or twisting until cleared by your specialist
• Lifestyle changes like weight management, posture correction, and regular exercise

How Long Does Recovery Take?

Recovery time after spinal stenosis surgery can vary depending on the type of procedure, the number of spinal levels involved, your overall health, and whether a fusion is performed.

• Minimally invasive decompression: Return to light activities 2 to 4 weeks
• Open decompression: Return to light activities 4 to 6 weeks.
• Spinal fusion: Return to light activities 6 to 12 weeks, with full recovery from 6 to 12 months
• Disc replacements (select patients): Return to light activities 2 to 4 weeks, with full activities from 6 to 12 weeks

What Is the Outlook for Spinal Stenosis?

With the right treatment, most people with spinal stenosis experience significant symptom relief and improved mobility. Conservative care often manages mild to moderate cases. For more serious cases, surgery offers excellent outcomes for reducing nerve compression and restoring quality of life.