Spinal stenosis: symptoms, causes, treatment and outlook

Symptoms depend on where the narrowing is. NHS inform notes that many people have none. When lumbar stenosis does cause symptoms, they are felt mostly in the legs rather than the back itself.

A hallmark feature described in the South Tees leaflet is leg pain brought on by standing or walking that settles with sitting or bending forwards, for example leaning on a shopping trolley. Bending forwards opens the spinal tunnel slightly, which is why it helps.

• Lower back (lumbar): pain, aching, cramping, heaviness or weakness in the legs, tingling, pins and needles or numbness.

• Neck (cervical): pain, stiffness, weakness, tingling or numbness in the arms, and sometimes headaches.

• Night-time leg cramps and a feeling of heaviness when walking are also mentioned by the South Tees leaflet.

• NHS inform says low back or neck pain on its own, without leg or arm symptoms, is usually not thought to be caused by stenosis.

The spine is a stack of bones with a central tunnel running through it. In the neck and upper back that tunnel holds the spinal cord. Lower down, it holds the bundle of nerve roots that go on to supply the legs. "Stenosis" simply means narrowing.

NHS inform explains that most narrowing is a normal part of the ageing process and often causes no trouble. A trust leaflet from South Tees adds that the nerve roots are structurally resilient, and that feeling pain does not by itself mean the nerves are being harmed.

Narrowing in the lower back is called lumbar stenosis. Narrowing in the neck is called cervical stenosis. Rarely, a person can have both at the same time.

NHS inform says many people cope because time allows the nerves to adapt. Options depend on symptoms, general health and personal preference. Exercise or physiotherapy is the main first step. NHS inform says exercise will not change the narrowing itself but can reduce nerve irritation and help function, strength and balance.

South Tees gives examples of exercise: a progressive cycling programme, an adjusted walking programme, or stretching. For intense or disabling pain, activities that do not provoke symptoms, such as swimming, may be suggested.

NHS inform lists lifestyle measures too: staying active, pacing, keeping to a healthy weight, stopping smoking and looking after emotional wellbeing. It also lists pain management strategies and medication. If these do not help, options include spinal injections, spinal surgery or specialist pain services.

Surgery means decompression of the nerve roots, often a laminectomy, where a small part of the spinal tunnel wall is removed. South Tees says it may be considered when symptoms are severe, there is progressive neurological decline, or after a period of exercise therapy, and that there is currently no definitive evidence that laminectomy improves symptoms for everyone. It adds that injections are not usually recommended.

Age-related change in the spine is the usual cause. Over time, discs, joints and ligaments can thicken or wear, leaving less room for the nerves. A Norfolk and Norwich University Hospitals page says spinal stenosis is usually caused by osteoarthritis of the spinal column.

NHS inform lists other causes: injury, rheumatoid arthritis, certain bone diseases, and being born with a narrow spinal canal. The South Tees leaflet says lumbar stenosis is very uncommon under the age of 50 and that the average age of people affected is between 62 and 69.

Pain is also shaped by things other than the narrowing. Poor sleep, stress and low mood can all make symptoms feel worse, according to both NHS inform and South Tees.

Diagnosis usually begins with a conversation and an examination. NHS inform says a healthcare professional will ask about symptoms and examine you, and may advise further checks to rule out other serious conditions. South Tees describes lumbar stenosis as a clinical diagnosis based on history, symptoms and examination.

Scans are not usually needed to make the diagnosis. They may be used when surgery is being planned for severe, limiting symptoms, or when a serious disorder is suspected. MRI is the scan most often used to show the nerves and spinal canal.

Not all leg pain is stenosis. South Tees points out that pain-sensitive structures in the back, hip and pelvis can cause similar pain, and that peripheral artery disease, where the blood supply to the legs is restricted, can mimic it. Part of the assessment is telling these apart.

Where the narrowing is determines which part of the body is affected. The table sets out how the two common forms differ, as described by NHS inform and the Norfolk and Norwich University Hospitals page.

NHS inform advises that for lumbar stenosis it is safe to keep walking as long as symptoms stay manageable, and that short regular walks are encouraged. If leaning forward eases the pain, plan breaks: sit down or lean against a wall. A walking aid may help if walking is a struggle.

On work, NHS inform says you do not need to be symptom-free before returning, and that staying in or returning to work as soon as possible helps recovery. Progression is usually slow. South Tees says up to 60% of people with mild to moderate symptoms improve quickly or stay the same over time.

Occasionally stenosis leads to cauda equina syndrome (nerves at the base of the spinal canal) or cervical myelopathy (the spinal cord in the neck). NHS inform calls both rare but serious, because they can cause permanent damage or disability if not treated early.

NHS inform says to contact your GP practice urgently, or phone 111 if it is closed, if you notice a new onset or significant worsening of any of these.

• Changes to bladder or bowel function, such as urgency, difficulty passing urine, leaking or incontinence.

• Altered feeling around the bottom or genitals, or sexual dysfunction.

• Reduced balance or difficulty walking.

• Pain, weakness, heaviness or changing sensation in the arms or legs.

• Clumsy hands, for example dropping things or struggling with buttons, handwriting or zips.

• Neck pain with a severe headache.

Most people start with a GP or a local musculoskeletal (MSK) service, where a physiotherapist assesses the problem and sets up an exercise programme. NHS inform says physiotherapy may be by referral or, in some areas, by self-referral.

If symptoms are not improving and other treatments have been tried, NHS inform lists spinal injections, spinal surgery and specialist pain services as further options. South Tees says surgery may be considered if symptoms are severe, if there is progressive neurological decline or after a period of exercise therapy, and that there is currently no definitive evidence that laminectomy improves symptoms for everyone.

Some people choose to see a private spinal or orthopaedic specialist for assessment or a second opinion. Because exercise is the recommended first step on either route, the main reasons to see a spinal surgeon are severe, worsening or limiting symptoms, or neurological warning signs.