The severity of the presentation differs from person to person depending on the body type. Size of the spinal canal does not affect the symptoms. Patients with spinal stenosis present with a chronic back pain. The symptoms vary with the location of the stenosis. However, pain, motor weakness, paresthesia and numbness of the lower limbs are the associated common symptoms.

Stenosis in the lumbar spine results in lumbago with radiculopathy. Urinary incontinence and loss over rectal control is seen in severe cases of spinal stenosis. Classical symptoms of lumbar stenosis include bilateral neurologic claudication.
Patients experience diffuse pain in the lower extremity which is intermittent and accompanied with paresthesiae. In a study conducted on 75 patients, it was observed that numbness, radiculopathy and neurologic claudication were present throughout in equal intensity. Neurologic claudication is aggravated with prolonged standing and descending and is relieved with elevation of extremity or by lying in a supine position [2].

The compensatory changes that develop eventually in patients of lumbar stenosis are leaning on to objects, posture changes like forward bending and slowing of gait.

Stenosis in the cervical spine results in a syndrome called cervical spondylotic myelopathy. Symptomatically there is proximal upper extremity weakness with loss of upper arm power. Later it may progress to ataxia due to compression of the spinocerebellar tracts.

Patients may also develop paresthesiae, weakness, upper arm radiculopathy and depressed reflexes depending on the level of nerve root impingement. In cases where there is inflammation of the ligamentum flavum or at the facetal joint capsule, the presentation may be asymptomatic as there is no nerve root compression. Such cases only show radiologic changes. In cases of metastasis of spine, the regional pain is present due to nerve root compression along with canal stenosis.

• Weakness

  […] at or below the level of involvement (43%) Pain or weakness in buttock / thigh only (8%) Pain or weakness below the knee (3%)[11] Neurological disorders[edit] Cervical (spondylotic) myelopathy,[12] a syndrome caused by compression of the cervical spinal [en.wikipedia.org]

  This may lead to pain, numbness, tingling, and/or weakness in the back and legs. This pain is especially noted while walking. [paradigmspine.com]

  Other symptoms of spinal stenosis can involve paresthesia, weakness or cramping in one or both extremities, rest pain, or burning pain, and are commonly misdiagnosed as peripheral neuropathy, especially in patients with diabetes. [ncbi.nlm.nih.gov]

• Intermittent Claudication

  Symptoms: Leg (neurogenic Intermittent Claudication) Characteristics Leg Fatigue (dullness) or Leg Weakness Leg numbness or Paresthesia s (tingling sensation) Bilateral Leg Pain (burning or cramping) Involves buttocks and thighs Spreads distally into [fpnotebook.com]

  Neurogenic intermittent claudication was 550 m on average. Follow-up period was 7.75 ± 2.28 months (range, 5-13 months). [ncbi.nlm.nih.gov]

  Calf symptoms may simulate those of intermittent claudication. Claudication can be differentiated by relief with rest (not position change), skin atrophy, and abnormalities in pulses, capillary refill, and vascular tests. [merckmanuals.com]

  The vascular claudication of PAD usually does not persist when resting in a standing position, unlike neurogenic intermittent claudications, which persist. [journals.lww.com]

  We present a patient who belongs to this particular group, with a discogenic pain syndrome; progressive legs weakness; numbness, followed by rapid worsening of symptoms, and onset of neurogenic intermittent claudication; no history of steroid therapy, [osti.gov]

• Weight Loss

  The most common non-surgical treatments include: Patient education Rest Weight loss Medication Chiropractic care Massage Acupuncture Physical therapy Injections Disclaimer: This content is for educational purposes only and does not replace having a conversation [paradigmspine.com]

  Common treatments for spinal stenosis include physical therapy, epidural steroid injections, anti-inflammatory medication, rest and weight loss. [barnesjewish.org]

  A healthy weight loss can take some stress off the back, particularly the lumbar portion of the spine. Working with a physical therapist can help too. [latimes.com]

• Lower Extremity Pain

  OBJECTIVES: To assess the cost utility of lumbar interlaminar epidural injections in managing chronic low back and/or lower extremity pain secondary to lumbar disc herniation, spinal stenosis, and axial or discogenic low back pain. [ncbi.nlm.nih.gov]

  It causes positional back pain, symptoms of nerve root compression, and lower-extremity pain during walking or weight bearing. [merckmanuals.com]

  It causes positional back pain, symptoms of nerve root compression in the foramina, and lower-extremity pain during walking or weight bearing. Spinal stenosis can be congenital or acquired. It may involve the cervical or lumbar spine. [msdmanuals.com]

  "Does this older adult with lower extremity pain have the clinical syndrome of lumbar spinal stenosis?". JAMA. 304 (23): 2628–36. doi:10.1001/jama.2010.1833. PMC 3260477. [en.wikipedia.org]

• Pallor

  Vascular disease is commonly associated with other problems such as impotence in men, dystrophic skin changes (nail atrophy, alopecia), foot pallor or cyanosis, decreased or absent peripheral pulses and arterial bruits. [aafp.org]

• Nausea

  Side effects include nausea, constipation, dizziness and drowsiness and use can result in dependency. All medication should be taken only as directed. [spine.org]

  One month postoperatively he returns to the office complaining of severe headaches and occasional nausea which is worse with standing. He denies fever or chills. On physical exam his wound is well healed with no cellulitis or erythema. [orthobullets.com]

  Important side effects Pain medications can cause drowsiness, slowness of breathing, difficulties in emptying the bladder and bowel, nausea, vomiting and allergic reactions. [orthop.washington.edu]

• Fecal Incontinence

  A 74-year-old woman appeared with urinary retention and fecal incontinence for the previous 24 hours. Computed tomography scan showed spinal stenosis from L2 to L4. [ncbi.nlm.nih.gov]

  Failure to receive quick treatment to relieve this pressure can result in: Permanent paralysis Urinary and/or fecal incontinence Loss of sexual sensation Weakness Pain or loss of feeling in one or both legs [nm.org]

  Fecal incontinence Other names Faecal incontinence, bowel incontinence, anal incontinence, accidental bowel leakage Diagram showing normal anatomy of anal canal and rectum. [en.wikipedia.org]

  Signs and symptoms of cervical stenosis include a spastic gait, upper extremity numbness, upper extremity and lower extremity weakness, radicular pain in the upper limbs, urinary incontinence, fecal incontinence, muscle wasting, sensory deficits, and [neurosurgery.ufl.edu]

• Vomiting

  Low back pain is accompanied by vomiting, fever, or both. Leg pain, weakness, numbness that comes and goes (intermittent), or tingling lasts longer than 1 week even though you use home treatment. [uwhealth.org]

  Important side effects Pain medications can cause drowsiness, slowness of breathing, difficulties in emptying the bladder and bowel, nausea, vomiting and allergic reactions. [orthop.washington.edu]

  After the withdrawal period is over the atopic dermatitis can cease or is less severe than it was before. [29] In children the short term use of steroids by mouth increases the risk of vomiting, behavioral changes, and sleeping problems. [30] Biosynthesis [en.wikipedia.org]

• Vascular Disease

  Other conditions that can be confused with stenosis include vascular claudication, peripheral vascular disease, and abdominal aortic aneurysms. [sfcustomchiro.com]

  Color atlas of peripheral vascular diseases. Mosby-Wolfe. p. 77. ISBN 978-0-7234-2074-3. ^ [ICD-10: R20.2] ^ [ICD-10: R25.1] ^ [ICD-10: G57.1] ^ "Chemotherapy-induced Peripheral Neuropathy". National Cancer Institute. [en.wikipedia.org]

  Pulses and vascularity of the leg should be normal. If not, the patient may also have concomitant vascular disease and vascular claudication. [uscspine.com]

• Ulcer

  Too many NSAIDs can cause ulcers and other stomach problems and, especially among older people, may increase the chance of heart attacks and strokes. They might also interact with other medicines. [webmd.com]

  They can lead to gastritis or stomach ulcers. If you develop acid reflux or stomach pains while taking an anti-inflammatory, be sure to talk with your doctor. Steroid injections. Cortisone is a powerful anti-inflammatory drug. [orthoinfo.aaos.org]

  "Corticosteroids and ulcers: is there an association?". Ann Pharmacother. 30 (7–8): 870–2. doi : 10.1177/106002809603000729. PMID 8826575. ^ Martínek J, Hlavova K, Zavada F, et al. [en.wikipedia.org]

• Back Pain

  Spinal stenosis may be in the neck, mid-back or low back. Spinal stenosis may cause just back or neck pain as well as accompanying arm pain or leg pain. Fortunately, surgery is not always necessary to relief spinal stenosis pain. [coxtechnic.com]

  Cold packs and heat therapy may help your pain during flare-ups. Treatments for back pain caused by spinal stenosis include: Medicines to help relieve back pain. [nlm.nih.gov]

  OBJECTIVES: To assess the cost utility of lumbar interlaminar epidural injections in managing chronic low back and/or lower extremity pain secondary to lumbar disc herniation, spinal stenosis, and axial or discogenic low back pain. [ncbi.nlm.nih.gov]

  As people age, it’s estimated that 8 of 10 adults experience back pain from life's normal wear and tear on the spine. One common cause of back pain is the narrowing of the spinal canal, called "spinal stenosis." [youtube.com]

• Leg Pain

  Spinal stenosis is in some patients the unidentified cause of failure of treatment of foot and leg pain. [ncbi.nlm.nih.gov]

  Spinal stenosis may cause just back or neck pain as well as accompanying arm pain or leg pain. Fortunately, surgery is not always necessary to relief spinal stenosis pain. Non-surgical relief for spinal stenosis may be achieved with Cox Technic. [coxtechnic.com]

  Patients with either condition will generally see the leg pain go away with rest, but spinal stenosis patients usually must sit for a few minutes to ease the leg pain and often the accompanying low back pain. [beaumont.org]

  Symptoms include back pain and numbness, weakness or tingling the legs or feet. Leg pain or cramping may also occur. [umms.org]

• Low Back Pain

  OBJECTIVES: To assess the cost utility of lumbar interlaminar epidural injections in managing chronic low back and/or lower extremity pain secondary to lumbar disc herniation, spinal stenosis, and axial or discogenic low back pain. [ncbi.nlm.nih.gov]

  Spinal stenosis may be in the neck, mid-back or low back. Spinal stenosis may cause just back or neck pain as well as accompanying arm pain or leg pain. Fortunately, surgery is not always necessary to relief spinal stenosis pain. [coxtechnic.com]

  Estimated costs to those who are severely disabled from low back pain range from $30-70 billion annually. [clinicaltrials.gov]

  Lumbar Spine Anatomy Helps You Understand Low Back Pain Now that you have learned about lumbar spine anatomy, perhaps you can better understand what's causing your low back pain. [spineuniverse.com]

• Neurogenic Claudication

  Neurogenic claudication is most frequently observed in patients with degenerative lumbar spinal stenosis. [ncbi.nlm.nih.gov]

  To assess the effects of nonoperative treatments for lumbar spinal stenosis with neurogenic claudication. [doi.org]

  NEUROGENIC CLAUDICATION Neurogenic claudication is a common symptom from lumbar spinal stenosis. Neurogenic claudication literally means cramping or painful legs from a nerve problem. [spinemd.com]

  claudication Lumbar spinal stenosis w neurogenic claudication Myelopathy due to spinal stenosis of lumbar region Neurogenic claudication co-occurrent and due to spinal stenosis of lumbar region Neurogenic claudication due to spinal stenosis of lumbar [icd10data.com]

  The presenting complaints were of weakness, numbness/tingling, radicular pain and neurogenic claudication in almost equal proportions. The commonest symptom was numbness or tingling of the legs. [sogacot.org]

• Osteophyte

  Etiology The causes of spinal stenosis can be divided into two groups 1 : bony structures facet osteophytes posterior vertebral body osteophytes (uncinate spurs) spondylolisthesis soft tissue structures herniated or bulging discs hypertrophy or bulking [radiopaedia.org]

  This friction can lead to the development of osteophytes, or bone spurs, which can encroach upon the nerve roots as they exit the spinal canal through the foraminal opening, or they can encroach centrally on the spinal cord itself. [spine-health.com]

  Disk herniation together with the formation of osteophytic spurs, hypertrophy of the articular facets and ligamentum flavum, and ossification of posterior longitudinal ligaments can lead to central and foraminal stenosis. [ncbi.nlm.nih.gov]

  Conditions that result in spinal stenosis Osteophytes—formation of bony spurs associated with osteoarthritis Herniated disk—protrusion of a cartilage disk between vertebrae Malignancy—cancer Scarring and inflammation of supporting spinal ligaments Abscess—localized [jamanetwork.com]

• Sciatica

  Diagnostic tests are the same as for sciatica (see Sciatica : Diagnosis ). Calf symptoms may simulate those of intermittent claudication. [merckmanuals.com]

  Acquired lumbar spinal stenosis (LSS) is a common cause of sciatica in middle-aged or elderly patients. [msdmanuals.com]

  Transcript of Exercises for sciatica: spinal stenosis EXERCISES FOR SCIATICA SPINAL STENOSIS My name is Sammy Margo.I'm a chartered physiotherapist. Today we're going to look at exercisesfor spinal stenosis. [nhs.uk]

  The pain caused by a ruptured disk in the lumbar spine is usually easy to diagnose and is known as sciatica. Sciatica usually causes back pain that shoots down one leg along the path of the sciatic nerve. [familydoctor.org]

• Paresthesia

  (Redirected from Paraesthesia) Paresthesia Other names Paraesthesia Pronunciation Specialty Neurology Paresthesia is an abnormal sensation of the skin (tingling, pricking, chilling, burning, numbness) with no apparent physical cause.[1][2] Paresthesia [en.wikipedia.org]

  Both patients complained of paresthesias and weakness in their lower extremities on postoperative day 1. Neurologic examination in each case was consistent with a polyradiculopathy. [ncbi.nlm.nih.gov]

  Patients may have pain, paresthesias, weakness, and diminished reflexes in the affected nerve root distribution. Rarely, spinal cord compression may cause cauda equina syndrome. [merckmanuals.com]

• Paresis

  Segmental zoster paresis is a rare complication of herpes zoster, characterized by focal motor weakness that does not always present simultaneously with skin lesions. Zoster paresis can be easily confused with other neuromuscular or spinal diseases. [ncbi.nlm.nih.gov]

  Rarely, sudden nerve rootlet compression resulting from LSS or a large disk herniation may cause cauda equina syndrome with distal leg paresis and sensory loss in and around the perineum and anus (saddle anesthesia), as well as bladder, bowel, and pudendal [merckmanuals.com]

  Clinically there is a development of paresis over a few days then paraplegia when the abscess is in the lumbar region or quadriplegia when it is located in the cervical area. spinal accessory nerve see accessory nerve, Table 14. congenital spinal stenosis [medical-dictionary.thefreedictionary.com]

• Numbness in the Buttocks

  Lumbar Spinal Stenosis • Pain, sciatica, tingling sensations, feelings of pins and needles, weakness or numbness in the buttocks, legs, calves. • Symptoms may increase when walking and decrease when sitting, bending forward, or lying down. • Rare: Bladder [ortho-spine.com]

  Symptoms of spinal stenosis include low back pain, buttock pain, leg pain and numbness. These symptoms are typically aggravated by walking and relieved by resting. [physio-pedia.com]

• Absent Ankle Reflex

  ankle reflexes, weakness were specific for diagnosis of LSS. [jpmrs.org]

• Urinary Incontinence

  Women with both problems have mixed urinary incontinence. [en.wikipedia.org]

  We report a case of a skeletally immature achondroplastic adolescent with significant thoracolumbar lordosis who presented with neurogenic claudication and urinary incontinence progressing over a 1-year period. [ncbi.nlm.nih.gov]

  Because the affected nerves have many functions, the condition may cause diverse problems in the lower body, including back pain, pain or numbness in the legs as well as constipation or urinary incontinence. [arthritis.org]

  Signs and symptoms of cervical stenosis include a spastic gait, upper extremity numbness, upper extremity and lower extremity weakness, radicular pain in the upper limbs, urinary incontinence, fecal incontinence, muscle wasting, sensory deficits, and [neurosurgery.ufl.edu]

MRI and CT scans remain the standard scanning procedures in order to study the site and extent of the spinal stenosis. MRI scans helps in viewing the spinal structure, bones, vessels and muscular ligaments, while CT scans provide information about the central canal, lateral recess, and the vertebral foraminae [5] [6].

Angiography is rarely indicated and is done only in suspected cases of vascular malformations. Neuronal studies include needle electromyography which detects lumbosacral radiculopathy along with axonal loss. Nerve conduction studies are done to helps to rule out neuropathies like peripheral neuropathy, tarsal tunnel syndrome etc. [7].

The aim to treatment of spinal stenosis is pain management and limiting the further disability. Non-surgical treatment includes analgesics, anti inflammatory agents and anti spasmodic, along with this physical therapy such as traction, exercises to strengthen muscles helps to reduce pressure and improves mobility.

Surgical intervention is indicated in cases of severe pain not responding to oral medications, neuropathy and radiculopathies [8].

Surgery includes lumbar decompressive laminectomy in which the nerves are decompressed by removing the roof of the vertebrae overlying the thickened ligaments. After this an interlaminal implant is placed between the two bones to in order to stabilize the joints [9] [10].

For neuropathic pain, tricyclic antidepressants are given but are not highly recommended due to their adverse effects especially in elderly age group. The radicular pain from the lateral recess stenosis is relieved by membrane–stabilizing anticonvulsants such as gabapentin and caramazepine. In patients not responding to medications and other physical therapies, epidural steroid injection provides relief. 

Patients undergoing surgery get good relief from the pressure symptoms as the compression of the affected nerve root gets released. Spinal stenosis results in morbidity more than mortality. This condition often causes disability and chronic pain rather than death. In individuals with spinal canal stenosis, the anterior cord compression causes a central spinal cord syndrome, likewise, a posterior cord compression causes partial dorsal column syndrome.

The spinal stenosis at the cervical or the thoracic region leads to compression symptoms leading to myelopathy and weakness in the lower extremity along with difficulty in maintain gait. In individuals with lumbar spinal stenosis, a study showed that about 90% of 169 patients showed symptomatic relief over the period of two years without undertaking any treatment. In another study of 32 patients suffering from moderate stenosis, no symptomatic change was observed in 70% of them despite taking conservative treatment for 4 years, while 15% showed improvement [4].

Spinal stenosis occurring congenitally is due to segmentation failure, achondroplasia or due to incomplete closure of the vertebral arch. Developmental anomalies include early vertebral arch ossification, vertebral wedging, osseous exostosis and thoracolumbar kyphosis.

Acquired causes include trauma, degeneration changes due to disc prolapsed, ligamentum flavum hypertrophy and spodylolisthesis.

Other causes include diseases such as Paget disease, fluorosis, acromegaly and malignancy. Cervical spinal stenosis results also from rheumatic arthritis and ankylosing spondylosis.

It is estimated that about 250,000 to 500,000 US residents have been suffering from the symptoms of spinal stenosis. This represents that spinal stenosis accounts to be a major health issue in the United States. About 1 in 1000 of the population in the age group older to 65 years suffers from this condition. It is more prevalent in the older age group. Of these, there are about 35% patients who are asymptomatic.

Lower lumbar spine is more prone to foraminal stenosis as the diameter of the dorsal root ganglion is larger than that of the foramen.

Among the Asians, cervical stenosis is more common. This is due to the ossification of the posterior longitudinal ligament. The longitudinal Framingham heart study recorded degenerative slip disc syndrome in about 1% of men and 1.5% female above the age group of 54. A Swedish study revealed 5 of 100,000 residents developed spinal stenosis with the canal diameter 11mm or less [2].

The spinal canal comprises of the spinal cord, cerebrospinal fluid and the dural membranes which capsules the cerebrospinal fluid. The prolapse of the intervertebral discs due to degeneration or due to trauma and other mechanical factors results in narrowing of the spinal canal and the lateral recesses. Along with the narrowing of the spinal canal, the other changes observed are, thickening of the posterior longitudinal ligament, and hypertrophy of the facet joints, epidural fat deposition and inflammation of the ligamentum flavum.

The degeneration leads to further subluxation of the vertebral bodies thus resulting in the spur formation. The common site for this is mainly the fifth, sixth and the seventh cervical vertebraes [3].

Simple measures like exercising regularly , going for daily walks, maintaining ideal body weight , maintaining a good posture and understanding one’s own body mechanics are ways to prevent back pathology. Doing regular exercises strengthens the muscles of the back and helps in shock absorbing in case sudden change of posture or trauma.

Spinal stenosis is a condition in which there is narrowing of the spinal canal. This is commonly seen in the lumbar and cervical spine. Lumbar spinal stenosis is often accompanied by nerve impingement. It includes central as well as lateral recess stenosis.

In lateral canal stenosis, as there is involvement of the nerve it results in severe radiculopathy, with muscle weakness, pain and immobility. This occurs due to a series of changes in the components of the central and lateral canal such as ligamentum flavum inflammation, bony spurs, epidural fat deposition and facetal hypertrophy [1].

Management of spinal stenosis includes conservative or surgical treatment. Conservative approach comprises of rest, analgesics, anti inflammatory medications, physical exercises, and weight loss. Surgery is done in patients who have severe pain, disability, neuropathy or malignancy.

Spinal stenosis occurs due to narrowing of the spinal canal. This leads to pressure to the surrounding nerves. Disc degeneration is the common cause of spinal stenosis. This leads to collapse of the disc space and compression of the facetal joints thus irritating the spinal nerves and giving rise to pain and numbness.

Treatment includes anti inflammatory drugs, pain killers, injections to relieve the numbness. Physical therapy such as traction and strengthening exercises are an important part of the overall regimen to be followed. Patients are instructed to avoid factors which can cause aggravation such as excessive lumbar extension or doing descending walks, or factors that can produce stress on the affected bone, and ligaments such lifting heavy weights they are encouraged to do more of exercises such as pilates, flexion training , gluteal strengthening, etc. [10].

1. Arnoldi CC, Brodsky AE, Cauchoix J, Crock HV et al. Lumbar spinal stenosis and nerve root entrapment syndromes. Definition and classification. Clin Orthop Relat Res. 1976 Mar-Apr; (115):4–5.
2. Kalichman L, Cole R, Kim DH, Li L, et al. Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J. 2009 Jul;9(7):545-50.
3. Truumees E. Spinal stenosis: pathophysiology, clinical and radiologic classification. Instr Course Lect. 2005;54:287-302.
4. Macnab I. Negative disc exploration: an analysis of the causes of nerve root involvement in sixty-eight patients. J Bone Joint Surg Am. 1971 Jul;53(5):891–903.
5. Herkowitz HN. Spinal stenosis: radiologic and electrodiagnostic evaluation. In:Rothman RH, Simone FA, (Eds) The spine. 3rd edition. Philadelphia: W.B. Saunders;1992. p. 830–57.
6. McAfee PC, Yaun H. Computed tomography in spondylolisthesis. Clin Orthop Relat Res. 1982 Jun;(166):62–71.
7. Johnson DW, Farnum GN, Latchaw RE, Erba SM. MR imaging of the pars interarticularis. Am J Roentgenol 1989 Feb;152(2):327-32.
8. Brown, LL. A double-blind, randomized, prospective study of epidural steroid injection vs. the mild (R) procedure in patients with symptomatic lumbar spinal stenosis. Pain Pract. 2012 Jun;12(5):333-41.
9. Eisenstein S. Lumbar vertebral canal morphometry for computerized tomography in spinal stenosis. Spine 1983 Mar;8(2):187–91.
10. Bridwell KH. Lumbar spinal stenosis. Diagnosis, management, antreatment. Clin Geriatr Med. 1994 Nov; 10(4):677–701.