Symptoms. Spinal Stenosis

What Are the Symptoms of Spinal Stenosis?

The primary clinical symptoms of spinal stenosis are chronic pain. In patients with severe stenosis, weakness and regional numbness may result. Patients with spinal stenosis become symptomatic when pain, motor weakness, paresthesia, or another neurologic compromise causes distress.

Spinal stenosis of the thoracic spine is more likely to directly affect the spinal cord because of the relatively narrow thoracic spinal canal. Spinal stenosis of the cervical and thoracic regions may contribute to neurologic injuries, such as the development of a central spinal cord syndrome following spinal trauma. Spinal stenosis of the lumbar spine is most commonly associated with midline back pain and radiculopathy. In cases of severe lumbar stenosis, innervation of the urinary bladder and the rectum may be affected, but lumbar stenosis most often results in back pain with lower extremity weakness and numbness along with the distribution of nerve roots of the lumbar plexus.

Spinal canal size is not always predictive of clinical symptoms of spinal stenosis, and some evidence suggests that body mass may play a role in limitations of function in this condition. Severe radiologic stenosis in otherwise asymptomatic individuals suggests inflammation, not just mechanical nerve root compression. Specific inflammation generators may include herniated nucleus pulposus (HNP), ligamentum flavum, and facet joint capsule.

Sometimes, people who have spinal stenosis have no symptoms of the condition. When symptoms start to appear, they usually come on gradually and slowly get more severe. The symptoms of spinal stenosis vary and depend on what part of the spine is affected. Evidence of spinal stenosis is usually apparent on X-ray.

• Symptoms in the Neck: If spinal stenosis is present in the neck (cervical area of the spine), it can cause pain and possibly tingling or numbness in the arms or the legs. If it is very severe, incontinence of bowel and/or bladder may result due to compression of the nerves that control these functions.
• Symptoms in the Lower Back: If spinal stenosis leads to nerve compression in the lumbar area (lower spine), symptoms of spinal stenosis might be muscle spasms, cramping, and leg pain with standing and walking. The pain is relieved by bending forward or sitting because this removes the pressure from the pinched nerves.

Lumbar spinal stenosis is strongly associated with advanced age, severe lower extremity pain, and absence of pain when the patient is in a flexed position. The most important elements involve the postural nature of the patient’s pain, stating that absence of pain or improvement of symptoms of spinal stenosis when seated assists in ruling in lumbar spinal stenosis. However, lumbar spinal stenosis cannot be ruled out when sitting is the most comfortable position for the patient and standing/walking is the least comfortable.

Patients with lumbar spinal stenosis compensate for symptoms by flexing forward, slowing their gait, leaning onto objects (e.g., over a shopping cart), and limiting the distance of ambulation. Unfortunately, such compensatory measures, particularly in elderly osteoporotic females, promote disease progression and vertebral fracture. Lumbar spine stenosis results in pain, numbness, or weakness, most often in the legs, feet, and buttocks.

Other symptoms of spinal stenosis are the following:

• Leg or buttocks pain and cramping, which gets worse on walking, standing straight, or leaning backward
• Stiffness in the leg and thighs
• Low back pain
• Loss of bladder and bowel control in severe cases

When Should I See a Doctor?

If you have pain that lasts more than a few days, or if you have numbness or weakness in your legs or arms, or bowel or bladder incontinence, notify your physician. These could be signs of spinal stenosis or a more serious medical condition.

Spinal Stenosis Diagnosis

It is not always easy to diagnose spinal stenosis since its symptoms mimic those of many other conditions common to aging. In order to diagnose the particular cause of your pain and other symptoms of spinal stenosis, your doctor may recommend several imaging tests. Recommended tests for spinal stenosis may include:

• X-rays: Standard X-ray films usually do not provide doctors with enough information to give a definitive diagnosis of spinal stenosis, but they do help rule out other reasons for your symptoms. 
• Magnetic Resonance Imaging (MRI): An MRI uses a strong magnetic field and radio waves to obtain images that a doctor can use to evaluate the condition of your spine and the body’s soft tissues to locate the area where physical symptoms of spinal stenosis are occurring. An MRI provides much more information than an X-ray, and many physicians recommend this test if they suspect spinal stenosis. 
• CT Myelogram: A Computerized Tomography (CT) uses X-rays taken from many angles and combines them to provide very detailed images. A myelogram involves the injection of a dye which helps specific structures to appear even more clearly. This is very useful in cases of suspected spinal stenosis diagnosis because it can show the size and shape of spinal canal and can reveal bone spurs, herniated discs, and abnormal growths and masses. 

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