What Is Stenosis of the Spine?

A Keck Medicine of USC spine surgeon shares what you need to know about spinal stenosis, a radiographic finding that can be present in over 40% of Americans above the age of 50.

Back pain, leg pain and sciatica are common complaints that bring patients to doctors’ offices. Many people do not realize that these symptoms can stem from a condition called spinal stenosis, a radiographic finding that can be present in over 40% of people in the United States as they age.

Spinal stenosis is a narrowing of the space in the spinal canal, causing compression of either the nerves or the spinal cord. It can occur at the level of the cervical spine (neck), the thoracic spine (mid-back) or the lumbar spine (lower back).

Most cases of spinal stenosis result from age-related changes like disc collapse, bone spurs or thickening ligaments. “It’s like hair going gray. It’s a natural aging process happening in the spine,” says Ram Kiran Alluri, MD, an orthopedic surgeon with the USC Spine Center, part of Keck Medicine of USC, specializing in neck and back disorders.

Spinal stenosis is quite common, Dr. Alluri notes, and it affects men and women equally. “Virtually anyone walking down the street above the age of 50 could have some degree of spinal stenosis,” he says. In addition to age, primary risk factors for spinal stenosis are genetics, smoking and obesity.

What causes spinal stenosis, and what are the symptoms of spinal stenosis?

Spinal stenosis does not cause problems in all people. Many people can be diagnosed with stenosis following magnetic resonance imaging (MRI) and yet have no symptoms, Dr. Alluri says. If a condition is not causing a clinical problem or interfering with a patient’s life, no intervention is necessary.

For those who do experience symptoms, however, symptoms typically begin with pain along specific nerve pathways, which may progress to numbness and weakness. Further symptoms can vary by location:

• Cervical (Neck): Can cause balance issues, fine-motor difficulties, shooting arm pain and, in severe cases, bowel/bladder changes
• Thoracic (Mid-Back): This rare form (less than 5% of cases) can cause leg weakness, numbness, difficulty walking and potentially bowel/bladder changes
• Lumbar (Lower Back): Can cause mild-to-serious symptoms, including sciatica (leg pain); weakness; numbness or tingling in the lower back; loss of coordination; cramping; or heaviness while walking, which improves when leaning forward (such as when you support yourself by leaning on a shopping cart while walking)

When should you seek immediate medical attention for spinal stenosis?

Red flag symptoms of spinal stenosis requiring medical care are acute onset of weakness or numbness, or bowel/bladder dysfunction, Dr. Alluri cautions.

“A lot of patients will come in describing classic sciatica symptoms and say, ‘I think I have a pinched nerve in my lower back.’ Oftentimes, they’re right,” Dr. Alluri adds. An MRI may be required to confirm the diagnosis.

The severity of a patient’s stenosis (mild, moderate or severe) is confirmed by imaging findings, but Dr. Alluri emphasizes that what shows up on an MRI screening does not always correlate with symptom severity. Some patients can have “severe” stenosis on MRI imaging and be asymptomatic, and other patients can have “mild” stenosis on MRI imaging and be in significant pain.

How to treat spinal stenosis

Approximately 70% of patients with cervical stenosis and about 90% with lumbar stenosis can get better with nonoperative treatment, Dr. Alluri says.

Nonsurgical approaches

Nonsurgical treatments typically combine physical therapy, medications (anti-inflammatories, muscle relaxers, nerve pain medications) and sometimes epidural injections.

Lifestyle modifications

Staying active, strengthening core muscles, maintaining good posture, quitting smoking and managing weight are crucial, Dr. Alluri says.

Surgical options

If symptoms continue after six weeks to six months of conservative treatment, surgical options may come next, including decompression (creating space for nerves in the spinal canal), spine fusion or disc replacement. Following surgery, most patients return to desk work within days, while manual laborers typically need about six to 12 weeks to recover, Dr. Alluri says.

When surgery is recommended, shared decision making is critical

Spinal stenosis naturally progresses with age, but preventive measures can slow its progression and minimize symptoms. Most spine surgeons will recommend surgery for neurologic symptoms that haven’t responded to nonsurgical approaches rather than recommending surgery for neck pain or back pain alone. When surgical intervention becomes a consideration, patients should be prepared to make informed decisions. The surgeon’s job is to explain the surgical options, but ultimately the patient has to make the tough decision of whether to proceed or not.

Patients should make sure that they have received adequate nonoperative treatment before proceeding with surgery.

Look for specialists through established spine centers such as the USC Spine Center. Most importantly, make sure you understand the goals of any proposed surgery.

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