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Spinal Stenosis

Spinal stenosis is a narrowing of the spinal canal, usually from age-related arthritis, that compresses nerves and causes back pain, leg pain, numbness, or weakness with standing and walking.

Musculoskeletal
Spinal stenosis is a narrowing of the spaces within the spine that puts pressure on the spinal cord and nerve roots. It most often affects the lower back (lumbar stenosis) or the neck (cervical stenosis) and is primarily a condition of adults over 50, because it usually develops from gradual, age-related changes in the spine. Because the narrowing itself takes years to develop, symptoms often creep up so slowly that people first attribute them to ordinary aging. Symptoms tend to progress slowly, and many people manage well for years with conservative treatment.

Causes

Anything that reduces the room available for the spinal cord and nerves can cause stenosis:
  • Arthritis of the spine: Osteoarthritis is the most common cause — bone spurs and enlarged facet joints gradually crowd the spinal canal.
  • Thickened ligaments: The ligaments that help hold the spine together can stiffen and buckle into the canal over time.
  • Bulging or herniated discs: Discs that flatten and bulge with age take up space needed by the nerves.
  • Other causes: Spinal injuries, slipped vertebrae (spondylolisthesis), and, less commonly, a congenitally narrow spinal canal.

Symptoms

Symptoms depend on where the narrowing occurs and how severely nerves are compressed. Unlike many back problems, lumbar stenosis often causes relatively little discomfort while sitting:
  • Neurogenic claudication: The classic pattern of lumbar stenosis — aching, heaviness, cramping, or numbness in the buttocks and legs that comes on with standing or walking and eases with sitting or leaning forward. Many people notice they can walk farther leaning on a shopping cart.
  • Radiating leg pain: Compression of an individual nerve root can cause sciatica-type pain, a form of lumbosacral radiculopathy.
  • Neck-related symptoms: Cervical stenosis can cause neck pain, numb or clumsy hands, and balance difficulty.
  • Emergency signs: New loss of bladder or bowel control or rapidly progressive weakness requires immediate evaluation.
Leg pain brought on by walking can also be caused by poor circulation from peripheral arterial disease, so an accurate diagnosis matters — vascular claudication eases with simply standing still, while stenosis pain typically requires sitting or bending forward.

Diagnosis

Your physician will take a history, examine your strength, reflexes, sensation, and gait, and check the circulation in your legs. When symptoms are significant or surgery is being considered, MRI is the preferred test to show where and how severely the canal is narrowed; X-rays can show arthritis and alignment problems. Keeping simple notes on how far you can walk before symptoms begin gives your physician a practical way to track the condition over time.

Treatment

Most people start with conservative measures, which often control symptoms well:
  • Physical therapy: Flexion-based exercises, core strengthening, and stationary cycling improve endurance and reduce symptoms.
  • Medications: NSAIDs such as naproxen help arthritis-related pain, and nerve-pain medicines such as gabapentin may ease radiating leg symptoms.
  • Activity adjustments: Interval walking with planned rest, and using an upright bike or pool for exercise, keep people active within their limits.
  • Epidural steroid injections: Can provide temporary relief of leg symptoms in selected patients.
  • Surgery: A laminectomy (removing bone and ligament to open the canal) is considered for progressive weakness or symptoms that seriously limit life despite conservative care.
Spinal stenosis is usually a marathon, not a sprint — ongoing management keeps most people walking and independent. The internal-medicine team at Zimmer Medical Group can evaluate your symptoms and coordinate imaging, therapy, and specialist care — schedule a visit if leg pain or numbness is cutting your walks short.

Related Medications

Commonly prescribed medications for this condition

GabapentinNaproxen

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