Spinal Stenosis

Spinal stenosis happens when the open spaces inside the spine become too narrow (Figure 1). This narrowing puts pressure on the spinal cord and the nerves that travel through the spine. It most often occurs in the lower back (lumbar spinal stenosis) or neck (cervical spinal stenosis). The main cause is age-related changes like arthritis, bone spurs, or thickened spinal ligaments. People over 50 are most likely to get it, though younger people can develop it if they have spinal injuries, scoliosis, or were born with a smaller spinal canal. The two most common forms of spinal stenosis are:

• Cervical Spinal Stenosis
• Lumbar Spinal Stenosis

Cervical Spinal Stenosis

Cervical spinal stenosis affects the neck. When nerves or the spinal cord are squeezed, symptoms can include neck pain, stiffness, numbness, tingling, or weakness in the arms or hands. If the spinal cord itself is compressed, people might have trouble walking, balance problems, or loss of coordination in their hands. This is a condition called cervical myelopathy. Cervical spinal stenosis causing cervical myelopathy can be more serious because it involves the spinal cord directly.

Diagnosing Cervical Spinal Stenosis

Diagnosis of cervical spinal stenosis begins with a physical exam where the doctor checks neck movement, reflexes, and sensation in the arms and legs. A diagnostic workup usually starts with x-rays of the neck. However, MRI scans are the best way to see the spinal cord and nerve roots. CT scans or X-rays may be used to detect bone spurs or alignment issues. In some cases, nerve tests (ex. electromyography) help determine how well the nerves originating from the neck area (cervical spinal nerves) are working.

Conservative Treatment for Cervical Spinal Stenosis

Mild to moderate cases are managed without surgery. Treatments may include physical therapy to improve posture and strengthen neck muscles, anti-inflammatory medications for pain relief, and steroid injections to reduce swelling. Wearing a soft neck collar for short periods can rest the neck, but long-term use is not advised because it may weaken muscles the muscles that support and move the neck. Gentle exercise and good posture habits are key to avoiding stiffness and worsening symptoms.

Surgical Treatment for Cervical Spinal Stenosis

Surgery is considered when spinal cord compression causes weakness, loss of balance, or severe pain that does not improve with conservative care. Common procedures include decompression surgery (removing bone or tissue pressing on the spinal cord) and spinal fusion to stabilize the neck. The main benefits are relief of pain and prevention of further nerve damage. Risks include infection, nerve injury, stiffness, nonunion of an attempted spinal fusion, and in rare cases, spinal cord injury.

Prognosis for Cervical Spinal Stenosis

Many people with mild cervical stenosis do well with regular monitoring and therapy. For those needing surgery, results are usually positive, especially if treated early before major nerve damage occurs. However, complications from surgery are a real possibility. Recovery may take several months, but most patients regain normal activity. Ongoing exercise, good posture, and neck care help maintain results and prevent recurrence.

Lumbar Spinal Stenosis

Listen to a Podcast on Lumbar Spinal Stenosis

Lumbar spinal stenosis affects the lower part of the back. Lumbar spinal stenosis is mainly caused by age-related changes in the spine that make the spinal canal narrower and press on the nerves. The most common causes include arthritis (which leads to bone spurs), thickening of spinal ligaments, and bulging or herniated discs. Less often, it can be caused by spinal injuries, tumors, or conditions a person is born with that make their spinal canal smaller than normal.. The pressure on nerves in this area can cause pain, tingling, numbness, or weakness in the lower back, buttocks, or legs. Many people notice symptoms get worse when standing or walking for a long time. In severe cases, the person may have trouble walking far or standing upright for more than a few minutes. Symptoms of lumbar spinal stenosis often improve when sitting or bending forward. Bending forward tends to improve symptoms in people with lumbar spinal stenosis because it temporarily increases the space within the spinal canal. When a person bends forward (flexes the spine), the vertebrae open slightly and the ligaments at the back of the spine stretch, which reduces pressure on the spinal nerves. In contrast, standing upright or leaning backward narrows the spinal canal and can pinch the nerves more tightly, leading to pain or tingling in the legs. This is why people with lumbar spinal stenosis often find relief when leaning on a shopping cart or walking slightly bent over.

Diagnosing Lumbar Spinal Stenosis

Doctors start by asking about symptoms and doing a physical exam. They check muscle strength, reflexes, and how easily a person can move. Imaging tests help confirm the diagnosis. X-rays show changes in bone structure or arthritis. MRI scans reveal soft tissues like nerves and discs and show where narrowing occurs. Sometimes, CT scans or special dye studies (CT myelograms) are used to get a more detailed picture of the spinal canal.

Conservative Treatment for Lumbar Spinal Stenosis

Most people start with non-surgical or “conservative” treatments. These include physical therapy to improve flexibility, strength, and posture. Anti-inflammatory medications like ibuprofen can ease pain and swelling. Short-term use of steroid injections near the spine may reduce nerve irritation. Doctors often suggest avoiding activities that worsen pain, using supportive shoes, and maintaining a healthy weight to reduce stress on the lower back.

Sample Conservative Treatment Plan for Low-Back Pain (pdf version)

Surgical Treatment for Lumbar Spinal Stenosis

Surgery is usually considered only if pain or weakness continues after months of conservative treatment, or if walking and daily activities become difficult. The most common surgery is decompression laminectomy, where the surgeon removes part of the bone or tissue pressing on the nerves. In some cases, spinal fusion is also done to stabilize the spine. The potential benefits of surgery are improved walking ability and reduced pain. Risks include infection, bleeding, nerve injury, failure of a spinal fusion to heal, or ongoing back stiffness.

Prognosis for Lumbar Spinal Stenosis

Most people with lumbar spinal stenosis improve with non-surgical care, though symptoms may come and go. Regular exercise, proper body mechanics, and maintaining a healthy lifestyle help manage the condition. After surgery, many patients experience long-term relief, but recovery can take several months and complications are a real possibility. Even with optimal treatment some people with lumbar spinal stenosis may still have mild back discomfort.

Edited by Stephen Pinney MD, November 6th, 2025