umbar spinal stenosis develops when the spinal canal and/or neuroforamen (nerve passageways) in the low back become narrow placing pressure on the spinal cord and/or nerve roots. Most people who have spinal stenosis have acquired it as a result of growing older, although a few individuals are born with a spinal stenosis (congenital spinal stenosis).

• Spinal arthritis(osteoarthritis, spondylitis) may contribute to bony spurs that develop on the facet joints.
• Bone spurs(called osteophytes) may encroach the spinal canal and/or lumbar nerve roots, and compress the spinal cord and/or nerves.
• Degenerative disc diseasein the low back may contribute to lumbar spinal stenosis. A disc may herniate near the foramen, a nerve passageway, compressing or entrapping a spinal nerve root.
• Spondylolisthesis(eg, vertebral body slides forward over the one beneath it)
• Degenerative lumbar scoliosis
• Patients with congenital spinal stenosis (eg, achondroplasia, short stature) may develop symptoms as early as age 15.
• When the spinal cord and/or nerve roots are compressed, pain and other symptoms often develop.

Lumbar spinal stenosis often affects one last three levels of the low back: L3-L4, L4-L5, and L5-S1. Sometimes more than one level is affected.

Red areas illustrate spinal cord/nerve root 
compression caused by Lumbar Spinal Stenosis

Symptoms of Lumbar Spinal Stenosis

Spinal stenosis in your lower back (lumbar spine) can cause pain or cramping in your legs when you stand for long periods of time or when you walk. The discomfort usually eases if you bend forward or sit down, but it comes back when you stand upright. Think of it this way: As you walk through the grocery store, does leaning forward on the grocery cart reduce your pain? Pain that eases when you bend forward is typical of lumbar spinal stenosis. This type of pain is sometimes called pseudoclaudication, false claudication, or neurogenic intermittent claudication.

Other symptoms of lumbar spinal stenosis besides pain may include numbness, weakness, or tingling in the leg or foot.

In severe cases of lumbar spinal stenosis, nerves to the bladder or bowel may be compressed, which can lead to partial or complete incontinence. If you're having problems controlling your bladder or bowel, you should seek immediate medical attention.

Causes of Spinal Stenosis

Primary vs. Acquired Spinal Stenosis

Doctors have 2 ways to categorize spinal stenosis. It can be primary, which means you've had it since birth—and that's considered a birth defect. Some people are born with spinal canals that are more narrow than most people's, and it may not present problems until later in life. This is a form of inherited stenosis called short pedicle syndrome. These patients are more prone to acquire stenosis in middle life.

Primary spinal stenosis isn't common, especially when compared to the other category for spinal stenosis: acquired.

Acquired spinal stenosis is the result of disease or injury to the spine, and the main types of acquired spinal stenosis will be covered in the next section.

What Causes Acquired Spinal Stenois?

The leading cause of acquired spinal stenosis is wear and tear on the spine due to aging. In fact, the most common direct cause of spinal stenosis isosteoarthritis, where the cartilage that cushions joints starts to degenerate due to age.

In addition to osteoarthritis, you can also develop spinal stenosis fromintervertebral disc problems. The intervertebral discs can bulge, or they can be ruptured or torn (a herniated disc). A bulging disc or fragments from a herniated disc can then protrude into the spinal canal or pinch on the nerve extending through the foramen. Ligaments connecting the vertebrae may also degenerate and allow the vertebrae to shift, which can pinch the spinal cord or nerves.

Risk factors for both osteoarthritis of the spine and for disc problems include aging, poor posture, high impact sports, and being overweight.

Injury to the spine can also cause spinal stenosis. For example, you may lift a heavy object without using proper lifting techniques. This can damage a disc or even move the vertebrae out of their normal alignment. Such injuries will put pressure on the spinal cord and nerve roots. You may also fracture part of your spine, and the fragments of bone can intrude on the spinal canal.

Exams and Tests for Spinal Stenosis

Diagnosing spinal stenosis can be challenging. The symptoms can mimic those of other conditions, plus the symptoms can come and go. To figure out the cause of your spinal stenosis, your doctor will need to perform several exams and tests. These exams and tests will also help the doctor develop a treatment plan for you—a way to manage your pain and other symptoms and to help you recover.

During your visit, your doctor will ask about your current symptoms and remedies you have already tried.  This is part of your physical exam.

You may also need to have some imaging tests done to help your doctor diagnose the cause of your spinal stenosis. You also may be asked to undergo additional tests, such as: bone scan and CT myelogram

What types of non-surgical treatments are available?
There are several non-surgical options your doctor may recommend to treat your spinal stenosis. Often, treatment combines more than one type of therapy. For example, medication may be combined with physical therapy. Let's review a few of the non-surgical therapies one by one.

• Medication:There is a wide variety of medications available to relieve inflammation, pain, and muscle spasm. Although some drugs are available over-the-counter (OTC), it is wise not to combine these with prescription drugs your doctor provides unless it is under his direction. Just like prescription medications, OTC drugs can cause serious side effects.
• Injections:The most common type of injection used to help alleviate the symptoms of spinal stenosis is an epidural injection. This type of injection places medication (usually a steroid) into the space that surrounds specific nerve roots (the epidural space). The medication helps to reduce inflammation and acute pain that radiates into the arms or legs. Usually a course of three injections are given over a period of several weeks.
• Physical therapy (PT):PT usually combines inactive therapy and therapeutic exercise. Inactive therapy includes heat or ice packs, ultrasound, electrical stimulation, and massage. These treatments help to ready the patient for active therapy by relaxing tight muscles and easing pain or discomfort. Therapeutic exercise includes stretching and prescribed exercises to help stabilize the spine, build strength and endurance, and increase flexibility.

Exercises for Spinal Stenosis

• If you are in pain from spinal stenosis, you probably don't even want to think about exercising.  However, as counterintuitive or impossible as it sounds, exercise, stretching, and movement can help relieve your spinal stenosis pain. Please, before starting any exercise regimen or activity, talk to your doctor. He or she may have recommendations for what types of exercise would be best for you, and he or she will be able to caution you against certain exercises.  Since your doctor knows your pain history and symptoms well, he or she is your best resource for information and recommendations.
• You should, in general, avoid any activities that put too much stress on your spine(contact sports, for example).

Walking is a suitable exercise for you if you have spinal stenosis.  It is low-impact, and you can easily vary the pace as needed.  Consider a daily walk (perhaps on your lunch break or as soon as you get home).  As a bonus, a daily walk is an excellent time to de-stress (if you need that), and, if you can swing it, a walk outdoors can be beautiful.

Swimming is also an ideal exercise because it exercises all your back muscles in a safe, supportive environment. The water supports your weight well, which means that there's less weight on your back.

You could also do water walking.

• acupuncture:Acupuncture practitioners believe that your body has an energy force called your Qi or Chi (pronounced "chee"). They think that when your Chi is blocked, you can develop physical illness. Acupuncture works to restore a healthy, energetic flow of Chi. (This Eastern approach to healing is different from Western scientific concepts. That doesn't make it better or worse; it just makes it different.) In acupuncture, the practitioner inserts fine needles into your body at specific points—and it doesn't hurt, honestly! There is some evidence that acupuncture may stimulate the release of endorphins, which are the body's own anti-pain chemicals.
• homeotherapy:This field includes a number of herbal medications and remedies that are helpful in reducing pain, including chondroitin sulfate, glucosamine, and hyaluronic acid.
• massage:You may find that a good massage eases your pain because it relaxes very tense muscles (and tension can add to your pain).

As with any treatment for back pain or neck pain, please talk to your doctor before you try something new.  For example, an herbal medication you take may actually interfere with another prescription or over-the-counter medication you're taking.  You don't want to unwittingly harm yourself, so talk to your doctor and make sure that you're clear to try a treatment.

Surgery for Spinal Stenosis

Most patients with spinal stenosis respond well to non-surgical treatments (such as medication), so you may not have to have surgery. However, there are situations when you may want to go ahead with spine surgery.

• You've tried non-surgical treatments and they haven't been successful.
• You've been in severe pain for a lengthy period of time.
• You're experiencing radiculopathy, which is a medical term used to describe pain, numbness, and tingling in the arms or legs.
• You've lost sensation in your arms or legs.
• You have decreased motor strength in your arms or legs.
• You've lost bowel or bladder control.

One main goal of spinal stenosis surgery is to free up area for your spinal cord and/or the nerve roots. That's called decompression. By giving your spinal cord and nerve roots more space to pass through, your spine surgeon hopes to decrease your pain from nerve inflammation.

Another goal of spinal stenosis surgery is to increase your motor strength in your arms or legs. If you've lost sensation in your arms or legs, your surgeon also hopes to restore that.