Spinal Stenosis

Get Back to Walking, Standing, and Living With Less Pain

Spinal stenosis occurs when the spaces around the spinal cord or spinal nerves become narrowed. When that narrowing begins to place pressure on the nerves, it can cause pain, numbness, tingling, weakness, or difficulty standing and walking.

Spinal stenosis most commonly affects the lower back (lumbar spinal stenosis) or the neck (cervical spinal stenosis).

At Molina Spine, our goal is simple: identify exactly what is causing your symptoms and use the least invasive treatment necessary to help you reclaim your active lifestyle.

What Is Spinal Stenosis?

Your spinal canal contains the spinal cord and nerves that travel from your spine to the rest of your body.

As we age, normal degenerative changes can gradually reduce the amount of space available for these nerves. Disc degeneration, bone spurs, enlarged joints, thickened ligaments, and other changes may all contribute to narrowing.

Importantly, an MRI showing spinal stenosis does not automatically mean that you need treatment or surgery.

Many people have narrowing on an MRI without significant symptoms. The most important question is whether the findings on your imaging actually match your pain, weakness, numbness, or limitations.

Lumbar Spinal Stenosis

Lumbar spinal stenosis occurs when nerves become compressed in the lower back.

One of the classic symptoms is neurogenic claudication — pain, heaviness, numbness, weakness, or fatigue in the buttocks or legs that becomes worse with standing or walking.

Common Symptoms of Lumbar Spinal Stenosis

Symptoms may include:

  • Low back pain

  • Buttock pain

  • Pain traveling into one or both legs

  • Numbness or tingling in the legs or feet

  • Leg weakness

  • Heaviness or fatigue in the legs

  • Difficulty walking longer distances

  • Symptoms that worsen when standing upright

  • Relief when sitting down or bending forward

  • Feeling better when leaning over a shopping cart

Some patients have surprisingly little back pain and primarily notice that their legs simply will not allow them to walk as far as they used to.

Why Does Leaning Forward Help?

Patients with lumbar spinal stenosis frequently notice that walking upright makes their symptoms worse, while sitting or leaning forward provides relief.

Bending forward can temporarily create more room around the nerves in the lower back.

That is why someone with significant lumbar stenosis may be able to ride a bicycle or lean over a shopping cart comfortably but struggle to walk through the same store while standing upright.

Cervical Spinal Stenosis

Spinal stenosis can also occur in the cervical spine, or neck.

When narrowing in the neck begins to compress the spinal cord, the condition may cause cervical myelopathy.

Symptoms can be very different from those caused by a pinched nerve.

Symptoms Can Include:

  • Neck pain

  • Numbness or tingling in the hands or arms

  • Arm weakness

  • Loss of hand coordination

  • Difficulty with buttons, handwriting, or other fine motor activities

  • Frequently dropping objects

  • Balance problems

  • Difficulty walking

  • Feeling unsteady on your feet

  • Weakness in the arms or legs

Spinal cord compression deserves particular attention because progressive cervical myelopathy can result in permanent neurologic dysfunction.

What Causes Spinal Stenosis?

Spinal stenosis is most commonly caused by degenerative changes that develop over time.

These can include:

Disc Degeneration

As a spinal disc loses height and hydration, it may bulge toward the spinal canal or neural foramen and reduce the space available for a nerve.

Arthritis and Bone Spurs

Arthritis of the facet joints can cause enlargement of the joints and formation of bone spurs, which may further narrow the spinal canal.

Thickened Ligaments

The ligamentum flavum runs along the inside of the spinal canal. With age and degeneration, it may become thicker and contribute to nerve compression.

Herniated or Bulging Discs

A disc protrusion can combine with other degenerative changes and further reduce the available space around a nerve.

Spondylolisthesis

When one vertebra slips forward relative to another, the resulting change in alignment may contribute to spinal stenosis.

Congenitally Narrow Spinal Canal

Some patients are simply born with less space inside their spinal canal. In these individuals, even relatively minor degenerative changes can produce symptoms.

Different Types of Spinal Stenosis

Not all stenosis occurs in the same place.

Central Canal Stenosis

Narrowing occurs in the main spinal canal.

In the lower back, this can compress multiple nerves and cause neurogenic claudication.

Lateral Recess Stenosis

Narrowing occurs where an individual nerve begins traveling toward its exit from the spinal canal.

Foraminal Stenosis

The neural foramen is the opening through which a spinal nerve exits the spine.

When this opening becomes narrowed, a single nerve may become compressed, producing symptoms similar to sciatica or cervical radiculopathy.

Determining where the stenosis is occurring and which nerve is affected is critical when deciding how it should be treated.

How Is Spinal Stenosis Diagnosed?

Diagnosis begins with your symptoms — not simply your MRI.

During your evaluation, we will typically review:

  • Where your pain occurs

  • What makes the symptoms better or worse

  • How far you are able to walk

  • Numbness or tingling

  • Muscle weakness

  • Reflexes

  • Balance and coordination

  • Previous treatments

  • Your imaging studies

MRI

An MRI is generally the best imaging study for evaluating the spinal cord, nerves, discs, ligaments, and degree of stenosis.

X-Rays

Standing X-rays may show arthritis, loss of disc height, abnormal alignment, instability, or spondylolisthesis that may not be completely appreciated on an MRI performed while lying down.

CT Scan

A CT scan may occasionally be used when greater detail of the bony anatomy is necessary or when an MRI cannot be performed.

Does Spinal Stenosis Always Require Surgery?

No.

Seeing the words “moderate stenosis” or even “severe stenosis” on an MRI does not automatically mean that you need an operation.

We treat patients — not MRI reports.

If your symptoms are manageable and there is no concerning neurologic dysfunction, nonsurgical treatment may be very reasonable.

At Molina Spine, our philosophy is less is more. Surgery is considered when the expected benefit outweighs the risks and when less invasive options are no longer providing an acceptable quality of life.

Nonsurgical Treatment for Spinal Stenosis

Depending on your symptoms, treatment may include:

Activity Modification

Temporarily modifying activities that repeatedly provoke symptoms can reduce irritation while you work toward improving strength and mobility.

Physical Therapy

Physical therapy may focus on:

  • Core strengthening

  • Flexibility

  • Hip and leg strength

  • Posture

  • Balance

  • Conditioning

  • Maintaining overall mobility

Medications

Anti-inflammatory medications or other medications may occasionally be appropriate depending on your health history and symptoms.

Spinal Injections

An epidural injection may help decrease inflammation surrounding an irritated spinal nerve and provide temporary symptom relief in selected patients.

An injection does not physically remove spinal stenosis, but it may reduce inflammation enough to improve pain and function.

When Is Surgery Considered?

Surgery may be considered when spinal stenosis causes persistent symptoms that significantly interfere with your quality of life despite appropriate conservative treatment.

Examples include:

  • Increasing difficulty walking

  • Severe leg pain with standing or walking

  • Persistent nerve pain

  • Progressive weakness

  • Significant numbness

  • Loss of function

  • Symptoms that no longer respond adequately to nonsurgical treatment

  • Spinal cord compression associated with cervical myelopathy

The purpose of surgery is usually to decompress the affected nerves or spinal cord by creating more space.

Spinal Stenosis Surgery

There is no single operation that is appropriate for every patient with spinal stenosis.

Your surgical plan should depend on:

  • The location of the stenosis

  • The number of levels involved

  • Whether the spine is stable

  • Whether spondylolisthesis is present

  • Previous spine surgery

  • Your anatomy

  • Your symptoms

  • Your overall health

  • Your activity goals

Lumbar Decompression

A decompression removes the specific bone, ligament, or other tissue responsible for compressing the nerves.

Depending on the individual patient, this may be performed through a traditional approach, minimally invasive approach, or endoscopic technique.

Endoscopic Spine Surgery for Spinal Stenosis

In appropriately selected patients, spinal stenosis may be treated using endoscopic spine surgery.

An endoscopic decompression uses a small camera and specialized instruments to access the area of nerve compression through a very small working channel.

The goal is the same as with any decompression:

Create enough space around the affected nerve while minimizing disruption of normal anatomy.

Potential advantages in appropriately selected patients may include:

  • Smaller incision

  • Less disruption of surrounding muscle

  • Less postoperative discomfort

  • Faster mobilization

  • Quicker return to normal activities

Endoscopic surgery is not the best option for every type of spinal stenosis. The decision depends on the exact location and cause of the nerve compression.

Do I Need a Fusion for Spinal Stenosis?

Not necessarily.

A decompression and a fusion are two different procedures.

Decompression

Removes pressure from the spinal nerves.

Fusion

Stabilizes two or more vertebrae so that they heal together.

If stenosis can be adequately treated while maintaining spinal stability, a decompression alone may be appropriate.

Fusion may be considered when significant instability, deformity, spondylolisthesis, or other structural problems are also present.

The goal should not be to perform the largest operation possible.

The goal is to perform the operation necessary to address the actual problem.

When Should Spinal Stenosis Be Evaluated Urgently?

Seek urgent medical evaluation if you develop:

  • New or rapidly progressive arm or leg weakness

  • Significant difficulty walking

  • New severe balance problems

  • Loss of bladder or bowel control

  • Numbness involving the groin or saddle region

These symptoms may indicate significant neurologic compression and should not be ignored.

Do You Have Spinal Stenosis?

If you have been told that your MRI shows spinal stenosis, the next step is determining whether it actually explains your symptoms.

At Molina Spine, we focus on identifying the specific pain generator or neurologic problem before recommending treatment.

Whenever possible, we begin with conservative treatment.

When surgery becomes necessary, we consider the least invasive treatment capable of effectively addressing the problem, including minimally invasive and endoscopic spine surgery when appropriate.

Reclaim Your Active Lifestyle

If back pain, leg pain, numbness, weakness, or difficulty walking is interfering with the activities you enjoy, schedule an evaluation with:

Domingo Molina IV, MD, FAAOS
Fellowship-Trained Orthopaedic Spine Surgeon

Molina Spine
140 W. Main St., Suite 100
Springfield, Ohio 45502

Phone: (937) 398-1066

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