Lumbar Spinal Stenosis: A Definitive

Guide

A. Cross section of normal lumbar spine

B. Cross section of lumbar spine with lumbar stenosis
1. Ligament Flavum
2. Exiting Nerve Root
3. Facet Joint (note enlarged facet joint in B as compared to A)
4. Dural sac with the nerve roots on the inside

Fig. 1: Stenosis

As we age, the spine changes, often leading to a degeneration of the vertebrae (bones), discs,
muscles and ligaments (connective tissues) that together make up the spinal column. These
changes may lead to spinal stenosis.

See What is Spinal Stenosis?

The term "stenosis" comes from the Greek word meaning "choking" and is often the result of
degenerative conditions such as osteoarthritis and/or degenerative spondylolisthesis. When
the spinal nerves in the lower back are choked, lumbar spinal stenosis occurs and most often
leads to leg pain and other symptoms, as described in more detail below.

Read more about Osteoarthritis of the Spine and Degenerative Spondylolisthesis

Lumbar Spinal Stenosis Symptoms

The typical symptom is increased pain in the legs with walking (pseudoclaudication), which
can markedly diminish one's activity level. Patients with lumbar spinal stenosis are typically
comfortable at rest but cannot walk far without developing leg pain. Pain relief is achieved,
sometimes almost immediately, when they sit down again.

For most people, symptoms of lumbar stenosis will typically fluctuate, with some periods of
more severe symptoms and some with fewer or none, but symptoms are not always
progressive over time. For each person, the severity and duration of lumbar stenosis
symptoms is different and often dictates whether conservative (non-surgical) treatment or
lumbar spinal stenosis surgery is more suitable.

See Spinal Stenosis Symptoms and Diagnosis

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The symptoms of lumbar stenosis generally develop slowly over time (most patients are over
50) and symptoms may come and go. Lumbar stenosis symptoms may include:

Leg pain (sciatica)

Leg pain with walking (claudication)
Tingling, weakness or numbness that radiates from the lower back into the buttocks
and legs.

As lumbar spinal stenosis symptoms worsen, they may become quite debilitating. It is
estimated that 400,000 Americans suffer from leg pain and/or low back pain from lumbar
spinal stenosis.

Lumbar Spinal Stenosis Causes

The cause of spinal stenosis in the lumbar spine is commonly associated with aging.
The facet joints (small stabilizing joints located between and behind vertebrae) tend to get
larger as they degenerate and can compress the spinal nerve roots in the lower back, often
producing lumbar stenosis symptoms of pain, especially with activity.
While rare, it is also possible for degenerative lumbar stenosis to develop in younger people
who have a curvature of the spinal canal or suffer a spinal injury.
Generally, patients with lumbar spine stenosis are comfortable sitting, but standing upright
further decreases the space available for the nerve roots and can block the outflow of blood
from around the nerve. Congested blood then irritates the nerve, causing pain. It is important
to note that lumbar stenosis that causes severe nerve damage is rare and that surgery is almost
always the patients decision.

Lumbar Spinal Stenosis Diagnosis

When a patient presents with the typical symptoms of lumbar spinal stenosis (leg pain, with
or without back pain, which is aggravated by walking), a conclusive diagnosis is made using
imaging studies from an MRI scan or a CT scan with myelogram (using an x-ray dye in the
spinal sack fluid). Physical examination alone does not yield a conclusive lumbar stenosis
diagnosis.
There are three major types of stenosis and accurate identification is vital to stenosis
treatment:

Lateral stenosis. The most common type of spinal stenosis, lateral stenosis occurs
when a nerve root that has left the spinal canal is compressed by either a bulging disc,
herniated disc or bone protrusion beyond the foramen (a bony, hollow archway
through which all spinal nerve roots run).
Central stenosis. Occurring when the central canal in the lower back is choked,
central stenosis may lead to compression of the cauda equina nerve roots (the bundle
of roots that branch off at the bottom of the spinal cord like a horse's tail).
Foraminal stenosis. When a nerve root in the lower back is pressed on and trapped
by a bone spur in the foramen, or the opening where the nerve root leaves the spinal
canal.

What is the difference between pseudoclaudication and

claudication?
Answers from Mayo Clinic Staff

Pseudoclaudication and claudication cause similar symptoms leg pain while

standing or walking but for different reasons.
Pseudoclaudication can be a symptom of lumbar spinal stenosis, a condition that
occurs when the spaces narrow between the vertebrae in your lower back. Normal
aging shrinks the disks that act as cushions between vertebrae. Bone spurs can
further reduce the space available in the spine.
The nerve roots that control movement and sensation in your legs pass through
narrow openings in your spine. If these openings become too narrow, they can put
pressure on the nerve roots and cause pseudoclaudication pain. The narrowing is
made worse by standing or walking. Pseudoclaudication pain is usually relieved by
sitting or lying down.
The pain associated with claudication occurs for an entirely different reason.
Claudication is caused by peripheral artery disease, a circulation problem that
decreases blood flow to leg muscles. The reduced amount of fuel and oxygen can
cause muscle pain, especially during exercise. Vascular claudication causes pain
when the muscles are in use and is relieved when the muscles are allowed to rest.

What is Spinal Stenosis?

While the term "stenosis" comes from Greek and means "choking," spinal stenosis, however,
has little in common with choking. So what is spinal stenosis?

There are two types of spinal stenosis: lumbar stenosis and cervical stenosis. While lumbar
spinal stenosis is more common, cervical spinal stenosis is often more dangerous because it
involves compression of the spinal cord, as explained below in more detail.

Lumbar Spinal Stenosis vs. Cervical Spinal Stenosis

In lumbar stenosis, the spinal nerve roots in the lower back are compressed, or
choked, and this can produce symptoms of sciatica -- tingling, weakness or
numbness that radiates from the low back and into the buttocks and legs - especially
with activity.
o See Lumbar Spinal Stenosis: A Definitive Guide
Spinal stenosis pain in the neck (cervical spinal stenosis) can be far more dangerous
by compressing the spinal cord. Spinal cord stenosis may lead to serious symptoms,
including major body weakness or even paralysis. Such severe spinal stenosis
symptoms are virtually impossible in the lumbar spine, however, as the spinal cord is
not present in the lumbar spine.
o See Cervical Stenosis with Myelopathy

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In rare cases, lumbar stenosis can go no further than to produce severe persistent disabling
pain and even weakness in the legs. Most cases of stenosis in the lumbar spine, however,
have pain that radiates into the leg(s) with walking, and that pain will be relieved with sitting.
This is called claudication, which can also be caused by circulatory problems to the legs, as
discussed later in this article.

Spinal Stenosis Pain in Older Patients

Spinal stenosis is related to degeneration in the spine and usually will become significant in
the 5th decade of life and extend throughout every subsequent age group. Most patients first
visit their doctor with symptoms of spinal stenosis at about age 60 or so. Patients need only
seek treatment for lumbar spinal stenosis if they no longer wish to live with significant
activity limitations, such as leg pain and/or difficulty with walking.
Spinal stenosis can occur in a variety of ways in the spine. Approximately 75% of cases of
spinal stenosis occur in the lumbar spine (low back), which is called lumbar spinal stenosis,
and most will affect the sciatic nerve which runs along the back of the leg. When this
happens, it is commonly called sciatica.