Spinal Stenosis

A narrowing of the spinal canal, causing pressure on the sciatic nerve roots and occasionally on the cord.

The pressure on the spinal cord may result from bony or soft tissue encroachment on the spinal cord or lumbosacral nerve roots. Neurogenic claudication (ie, aching pain with or without paresthesia or numbness in the buttocks, thighs, or calves) is characteristic. Discomfort is caused by prolonged lumbar extension (eg, while walking) and relieved by lumbar flexion (eg, while sitting or leaning forward). Mild to moderate low back pain and symptoms of radicular nerve root compression may be present. Physical findings are often nonspecific. The presence of brisk peripheral pulses helps exclude peripheral vascular disease as a diagnosis.

Diagnosis can be confirmed by CT or MRI. However, many asymptomatic elderly persons have the pathologic changes of spinal stenosis on imaging studies. Thus, careful clinical judgment must be used to determine whether spinal stenosis found on x-ray is the cause of the patient's symptoms.

Treatment for most patients includes an initial course of analgesics and exercise. If a patient does not respond to this approach or if function is severely compromised, spinal decompression by surgery is indicated.