Lumbar Spinal Stenosis: Symptoms and Treatment

Lumbar spinal stenosis is narrowing of the spaces within the lower spine that can reduce the space available for the spinal nerves. Some people have narrowing without significant symptoms, while others develop pain, heaviness, numbness or weakness in the legs, particularly during standing or walking.

Treatment depends on the severity of the symptoms, their effect on mobility and everyday life, clinical findings and the degree to which abnormalities seen on imaging correspond with the patient's symptoms. Many people can initially be managed without surgery, while selected patients with significant persistent symptoms may benefit from specialist assessment and consideration of decompression surgery.

What Is Lumbar Spinal Stenosis?

The lumbar spine is the lower part of the spine. It contains a central spinal canal and smaller spaces through which the spinal nerves travel.

Lumbar spinal stenosis occurs when one or more of these spaces becomes narrowed. Depending upon the location and extent of the narrowing, this can place pressure on the nerves supplying the legs.

The condition is more common with increasing age because several age-related changes within the spine can contribute to narrowing around the nerves.

What Causes Lumbar Spinal Stenosis?

Lumbar spinal stenosis commonly develops as a result of degenerative changes within the spine over time.

Several structural changes can contribute to the reduction in space available for the nerves, including:

changes in the intervertebral discs
disc bulging
degenerative changes affecting the facet joints
thickening or buckling of ligaments within the spine
changes in the shape or alignment of the spinal canal
spondylolisthesis, where one vertebra moves relative to another

More than one of these changes can occur at the same time.

Importantly, age-related changes on an MRI scan are common. The presence of spinal narrowing on imaging does not automatically mean that it is responsible for a person's symptoms.

What Are the Symptoms of Lumbar Spinal Stenosis?

Symptoms vary depending upon which nerves are affected and how significantly the narrowing interferes with them.

Possible symptoms include:

pain in one or both legs
heaviness or aching in the legs
tingling or pins and needles
numbness or altered sensation
weakness in the legs
reduced walking distance
lower back pain in some patients

One of the characteristic presentations is the development of leg symptoms during standing or walking, with improvement when sitting down or bending forwards.

Why Does Spinal Stenosis Cause Pain When Walking?

Some people with lumbar spinal stenosis find that they can initially walk normally, but pain, heaviness, numbness or weakness gradually develops in the legs as they continue walking.

The symptoms may become severe enough that the person needs to stop and sit down before continuing.

This pattern is known as neurogenic claudication. It occurs because narrowing within the lumbar spine affects the spinal nerves, with symptoms commonly becoming more noticeable when the spine is in an extended or upright position.

Sitting or bending forwards can increase the available space within parts of the spinal canal, which helps explain why symptoms may improve in these positions.

What Is Neurogenic Claudication?

Neurogenic claudication describes leg symptoms caused by narrowing around the spinal nerves.

A person may experience:

pain in the buttocks or legs
aching or heaviness
numbness or tingling
weakness or fatigue in the legs

Symptoms are typically associated with standing or walking and improve when sitting or bending forwards.

Some patients notice that they can walk further when leaning forwards, for example over a shopping trolley, than when walking completely upright.

Not everyone with lumbar spinal stenosis has exactly this symptom pattern, but neurogenic claudication is an important clinical feature of the condition.

Is Spinal Stenosis the Same as Sciatica?

No, although spinal stenosis can cause sciatic-type symptoms.

Sciatica describes symptoms resulting from irritation or compression of a nerve supplying the leg. A prolapsed disc is one possible cause, but narrowing from spinal stenosis can also affect individual nerve roots.

Some people with stenosis therefore experience pain travelling along one leg in a pattern similar to sciatica.

Others have a broader pattern of pain, heaviness, numbness or weakness affecting both legs, particularly during standing and walking.

Is Lumbar Spinal Stenosis the Same as a Slipped Disc?

No.

A slipped or prolapsed disc occurs when disc material protrudes beyond its normal position. If this compresses a spinal nerve, it can cause sciatica.

Lumbar spinal stenosis describes narrowing of the spaces available for the spinal nerves and is commonly associated with a combination of degenerative changes.

The two conditions are different, although disc bulging can contribute to spinal stenosis and both conditions can be present in the same patient.

Can Lumbar Spinal Stenosis Cause Back Pain?

Yes, some people with lumbar spinal stenosis also experience lower back pain.

However, the symptoms that often lead to consideration of treatment for stenosis are related to nerve compression and its effect on the legs and walking ability.

A patient may therefore have significant spinal stenosis with relatively modest back pain but substantial difficulty standing or walking because of leg symptoms.

Conversely, the presence of lower back pain and spinal narrowing on an MRI does not necessarily mean that the stenosis is the source of the back pain.

Can Spinal Stenosis Cause Numbness or Weakness?

Yes. Compression of spinal nerves can affect sensation and muscle function as well as causing pain.

Symptoms may include:

numbness in part of one or both legs
pins and needles
altered sensation
weakness affecting particular muscles
a feeling of heaviness or fatigue in the legs

Significant or progressive weakness requires appropriate medical assessment.

How Is Lumbar Spinal Stenosis Diagnosed?

Diagnosis involves combining the patient's symptoms and clinical examination with imaging where appropriate.

A specialist may ask about:

the location of pain or altered sensation
whether one or both legs are affected
how far the patient can walk before symptoms develop
whether standing brings on symptoms
whether sitting or bending forwards provides relief
numbness, tingling or weakness
lower back symptoms
the effect on mobility and everyday activities
previous treatment

A clinical examination may include assessment of movement, muscle strength, sensation, reflexes and walking.

If the symptoms suggest lumbar spinal stenosis and the result is likely to influence management, imaging may then be appropriate.

Does Lumbar Spinal Stenosis Require an MRI Scan?

MRI is commonly used when symptomatic lumbar spinal stenosis is being investigated.

An MRI can show the spinal canal, discs, nerves and other structures in detail and help identify:

where narrowing is occurring
which nerves may be affected
how many spinal levels are involved
whether disc or joint changes are contributing
whether another spinal condition is present

However, the scan must be interpreted alongside the clinical symptoms.

Spinal narrowing visible on MRI does not necessarily require treatment if it is not causing clinically significant symptoms.

How Is Lumbar Spinal Stenosis Treated?

Treatment is individualised according to the symptoms, degree of functional limitation, general health, examination findings and imaging.

Not everyone with lumbar spinal stenosis requires an operation.

For people with manageable symptoms and no indication for urgent surgical treatment, non-surgical management may initially be appropriate.

Activity and Exercise

Remaining appropriately active can be important. Exercise and rehabilitation may help maintain mobility, strength and general physical function.

The type and intensity of exercise should take account of the individual's symptoms, general health and physical capabilities.

Physiotherapy and Rehabilitation

Physiotherapy may be used to help improve movement, strength and function and to provide advice about managing activities that provoke symptoms.

Although rehabilitation does not physically enlarge the spinal canal, it can help some patients manage their symptoms and maintain function.

Medication

Medication may sometimes be used as part of symptom management. The appropriate choice depends upon the nature of the symptoms, the patient's general health, other medication and potential side effects.

Medication should be discussed with an appropriate healthcare professional.

Are Spinal Injections Used for Lumbar Spinal Stenosis?

Injections are sometimes discussed in patients with spinal conditions, but their role depends upon the nature of the symptoms and the underlying diagnosis.

For central spinal canal stenosis causing neurogenic claudication, NICE guidance advises against using epidural injections as a treatment for the claudication itself.

This differs from some cases of acute and severe sciatica, where an epidural injection of local anaesthetic and steroid may be considered.

This distinction is one reason why establishing the cause and pattern of leg symptoms is important before treatment is recommended.

When Is Surgery Considered for Lumbar Spinal Stenosis?

Surgery may be considered when spinal stenosis causes significant persistent symptoms that substantially affect walking, mobility or quality of life and non-surgical management has not provided sufficient improvement.

The decision takes account of factors including:

the severity of the leg symptoms
walking limitation
numbness or weakness
how long symptoms have been present
the effect on normal activities and independence
response to previous treatment
clinical examination findings
the location and severity of narrowing on imaging
general health and suitability for surgery
the expected benefits and risks of an operation

The presence of stenosis on an MRI scan alone is not an indication for surgery.

What Is Lumbar Decompression Surgery?

When surgery is appropriate, the objective of lumbar decompression is to create more space for the affected spinal nerves.

The exact procedure depends upon where the compression is occurring and which structures are responsible.

Decompression may involve removing a portion of bone or ligament that is contributing to narrowing around the nerves. The surgical approach is tailored to the individual anatomy and pattern of nerve compression.

The purpose of the operation is principally to relieve symptoms caused by nerve compression. The likely effect on back pain needs to be considered separately and discussed before surgery.

Does Spinal Stenosis Always Require Fusion Surgery?

No.

Lumbar spinal stenosis does not automatically require spinal fusion. In some patients, decompression of the affected nerves may be considered without fusion.

Whether additional stabilisation is appropriate depends upon individual factors such as spinal alignment, instability, associated conditions and the type of decompression required.

The decision should therefore be based upon the individual patient's symptoms, imaging and surgical assessment rather than the diagnosis of spinal stenosis alone.

Can Lumbar Spinal Stenosis Get Worse?

The course of lumbar spinal stenosis varies considerably between individuals.

Some people have relatively stable and manageable symptoms, while others experience increasing difficulty with standing, walking or neurological symptoms over time.

Changes visible on an MRI scan do not necessarily predict how quickly an individual's symptoms will progress.

Reassessment may be appropriate if symptoms are worsening, walking ability is becoming increasingly restricted or new neurological symptoms develop.

When Should I See a Spine Specialist?

Specialist assessment may be appropriate when symptoms potentially caused by lumbar spinal stenosis are persistent, significantly limit walking or normal activities, or when the diagnosis or appropriate treatment remains uncertain.

Assessment may also be helpful if imaging has already demonstrated spinal stenosis but it is unclear whether the findings explain the symptoms.

A specialist can assess the clinical pattern, examine neurological function, review imaging and discuss whether non-surgical treatment or surgery may be appropriate.

When Does Lumbar Spinal Stenosis Require Urgent Assessment?

Lumbar spinal stenosis usually develops gradually and does not normally require emergency treatment. However, new or rapidly worsening neurological symptoms require medical assessment.

Seek urgent or emergency medical help if back or leg symptoms are associated with new difficulty controlling or passing urine or stools, loss of sensation around the genitals or anus, or significant or worsening weakness or numbness affecting both legs.

These symptoms can have different causes but may indicate significant compression of the nerves in the lower spine, including cauda equina syndrome.

Severe or rapidly changing neurological symptoms should not be assessed solely using online information.

Frequently Asked Questions About Lumbar Spinal Stenosis

What does lumbar spinal stenosis feel like?

Symptoms vary, but some people experience pain, aching, heaviness, numbness or weakness in one or both legs. A characteristic pattern is symptoms developing during standing or walking and improving when sitting or bending forwards.

Can spinal stenosis make walking difficult?

Yes. Neurogenic claudication caused by lumbar spinal stenosis can progressively limit the distance a person can stand or walk before leg symptoms require them to stop and rest.

Does spinal stenosis always get worse?

No. The progression of symptoms varies between individuals. Some people have stable symptoms that can be managed without surgery, while others develop increasing functional limitation or neurological symptoms.

Does lumbar spinal stenosis require surgery?

No. Surgery is generally considered for selected patients whose symptoms remain significant, substantially restrict function or mobility and correspond with nerve compression demonstrated on imaging. Many people can initially be managed non-surgically.

Can an MRI show spinal stenosis?

Yes. MRI can show narrowing within the spinal canal and around the spinal nerves. However, imaging findings need to be considered alongside the patient's symptoms because narrowing can be present without causing significant clinical problems.

Can spinal stenosis cause sciatica?

Yes. If narrowing affects an individual lumbar nerve root, spinal stenosis can cause pain, numbness, tingling or weakness in a pattern similar to sciatica. Other patients experience broader symptoms affecting both legs during standing or walking.

Does spinal stenosis cause back pain or leg pain?

It can cause both, but symptomatic lumbar spinal stenosis is often particularly associated with leg symptoms and reduced walking tolerance caused by compression of the spinal nerves.

About This Article

This article provides general information about lumbar spinal stenosis, its symptoms, investigation and treatment. It is not intended to diagnose an individual's symptoms or replace personalised medical advice.

Medically reviewed by Professor Nasir A. Quraishi
Consultant Spinal Surgeon & Honorary Professor

Clinical sources: NICE guidance on low back pain and sciatica in people aged 16 and over, and NHS information about lumbar decompression surgery and spinal conditions.

Further Information

If leg symptoms, back pain or difficulty walking may be related to lumbar spinal stenosis, specialist assessment can help establish whether nerve compression is responsible and whether further investigation or treatment may be appropriate.

Learn more about Lumbar / Back Pain

Learn more about Leg Pain / Sciatica

What Causes Lower Back Pain?
MRI Scans for Lower Back Pain: When Are They Needed?
When Should I See a Spine Specialist for Back Pain?
Slipped Disc: Symptoms, Diagnosis and Treatment
When Does Back Pain Require Surgery?