Lumbar Spinal Stenosis

Also known as: Lumbar stenosis, Lumbar canal stenosis, Lumbar spinal canal stenosis, Degenerative lumbar spinal stenosis, Lumbar foraminal stenosis, Lumbar nerve root stenosis, LSS (lumbar spinal stenosis), Narrowing of the spinal canal in the lower back

Last updated: December 18, 2024

Lumbar spinal stenosis is a gradual narrowing of the spinal canal or nerve openings in the lower back that can compress the spinal cord, cauda equina, or nerve roots. It may cause lower back pain and neurogenic claudication, with leg pain, heaviness, or weakness during walking or standing that can improve with sitting or leaning forward. Options include activity modification, and symptoms may stay stable or slowly worsen.

Key Facts

•Lumbar spinal stenosis involves narrowing of the spinal canal or neural foramina in the lower back, which compress the spinal cord, cauda equina, or nerve roots
•Neurogenic claudication: leg pain, heaviness, or weakness that occurs with walking or prolonged standing and improves with sitting or leaning forward
•Diagnosed through history, physical exam, and imaging
•First-line treatment includes exercise, weight management, and activity modification

What It Is

Lumbar spinal stenosis involves narrowing of the spinal canal or neural foramina in the lower back, which may compress the spinal cord, cauda equina, or nerve roots. This narrowing typically develops gradually due to degenerative changes and may cause back pain, leg pain, numbness, or weakness, often worsened by walking or standing.

Affected Anatomy

This condition affects several structures in and around the joint:

•Spinal canal of the lumbar spine
•Neural foramina (openings where nerve roots exit)
•Intervertebral discs (may bulge and contribute to narrowing)
•Facet joints (may enlarge due to arthritis)
•Ligamentum flavum (may thicken with age)
•Lumbar nerve roots and cauda equina
•Vertebral bodies and pedicles

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

•Neurogenic claudication: leg pain, heaviness, or weakness that may occur with walking or prolonged standing and often improves with sitting or leaning forward
•Lower back pain that may be diffuse or localized
•Numbness or tingling in the buttocks, legs, or feet
•Weakness in the legs that may affect walking or balance
•Symptoms may be relieved by sitting, bending forward, or pushing a shopping cart (flexed posture)
•Difficulty walking longer distances without needing to rest
•In severe cases, bowel or bladder dysfunction may occur and requires urgent evaluation

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

•Degenerative changes of aging, including disc bulging, facet joint hypertrophy, and ligament thickening
•Osteoarthritis of the spine leading to bone spur formation
•Disc degeneration and loss of disc height may contribute to foraminal narrowing
•Spondylolisthesis (vertebral slippage) may contribute to canal narrowing
•Congenital spinal stenosis (present from birth) may predispose some individuals to earlier symptoms
•Prior spine surgery or trauma may contribute in some cases

Risk Factors

•Age over 50 years, as degenerative changes accumulate over time
•Osteoarthritis or degenerative joint disease of the spine
•Congenitally narrow spinal canal may increase susceptibility
•Prior spine injuries or surgeries
•Occupations or activities involving repetitive spine loading
•Obesity may increase mechanical stress on the spine
•Conditions affecting bone metabolism or causing abnormal bone growth

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

•Medical history focusing on characteristic neurogenic claudication symptoms and their relationship to posture and activity
•Physical examination assessing gait, posture, neurological function, and provocative maneuvers
•Walking tolerance assessment may help characterize functional limitation
•MRI is typically the preferred imaging study for visualizing soft tissue structures and neural compression
•CT scan may provide detailed bone anatomy and can be used if MRI is contraindicated
•CT myelography may be used in complex cases or when MRI is not possible
•Plain X-rays may show alignment, degenerative changes, and spondylolisthesis but do not directly visualize the spinal canal

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

•Activity modification, such as using a cane or shopping cart to encourage flexed posture
•Gabapentinoids or other medications may help manage neuropathic symptoms in some cases
•Weight management to reduce mechanical load on the spine

Physical Therapy and Exercise

•Physical therapy focusing on flexion-based exercises, core strengthening, and aerobic conditioning

Medications

•Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce pain for some individuals

Injections and Office-Based Procedures

•Epidural steroid injections may provide temporary symptom relief for some patients

Surgery

•Surgical decompression (laminectomy) may be considered for patients with significant functional limitation despite conservative treatment
•Spinal fusion may be added when instability or spondylolisthesis is present

Prognosis and Recovery

The course of this condition varies between individuals:

•Symptoms often develop gradually and may remain stable or progress slowly over time
•Many individuals can manage symptoms with conservative measures and activity modification
•Walking tolerance and quality of life may be significantly affected in moderate to severe cases
•Surgical decompression generally provides good outcomes for appropriately selected patients
•Some patients may experience symptom recurrence or progression of degenerative changes over time

Frequently Asked Questions

Common symptoms include: Neurogenic claudication: leg pain, heaviness, or weakness that may occur with walking or prolonged standing and often improves with sitting or leaning forward; Lower back pain that may be diffuse or localized; Numbness or tingling in the buttocks, legs, or feet; Weakness in the legs that may affect walking or balance; Symptoms may be relieved by sitting, bending forward, or pushing a shopping cart (flexed posture).

Diagnosis typically involves: Medical history focusing on characteristic neurogenic claudication symptoms and their relationship to posture and activity; Physical examination assessing gait, posture, neurological function, and provocative maneuvers; Walking tolerance assessment may help characterize functional limitation; MRI is typically the preferred imaging study for visualizing soft tissue structures and neural compression.

Treatment options range from conservative measures to surgical interventions, including: Activity modification, such as using a cane or shopping cart to encourage flexed posture; Physical therapy focusing on flexion-based exercises, core strengthening, and aerobic conditioning; Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce pain for some individuals; Epidural steroid injections may provide temporary symptom relief for some patients; Gabapentinoids or other medications may help manage neuropathic symptoms in some cases.