Lumbar spinal stenosis is a condition in which the spinal canal in the lower back narrows and compresses the nerves traveling through it. This narrowing typically causes leg pain, heaviness, numbness, or weakness that worsens with standing and walking and improves with sitting or bending forward. At our spine clinic serving Parker, Lone Tree, Centennial and the surrounding Denver metro area, lumbar spinal stenosis is one of the most common conditions we see, particularly in patients over 60. One of the most common complaints is, “I have difficulty walking any distances now.” or “I have to lean on the shopping cart just to get through the store,”
What Causes Lumbar Spinal Stenosis?
Lumbar spinal stenosis is most often caused by degenerative changes that accumulate over time. These changes include thickening of the ligamentum flavum, enlargement of the facet joints, disc bulging, and bone spur formation. Together, these changes gradually narrow the central spinal canal where the nerves travel.
Degenerative spondylolisthesis, where one vertebra slips forward on another due to facet joint arthritis, is a common contributor to stenosis. Less frequently, stenosis can result from congenitally narrow spinal canals, trauma, or prior surgery.
Symptoms of Lumbar Spinal Stenosis
The hallmark symptom of lumbar spinal stenosis is neurogenic claudication. This refers to leg discomfort that develops with standing or walking and is relieved by sitting or leaning forward. Patients often describe their legs feeling heavy, tired, weak, or numb after walking a certain distance.
Many patients notice they can walk longer when pushing a shopping cart or leaning on a walker because the forward-flexed position opens up space in the spinal canal. Sitting provides relief because it also flexes the spine and reduces pressure on the nerves.
Symptoms are often gradual in onset and slowly progressive. Both legs are frequently affected, though one side may be worse than the other.
How Lumbar Spinal Stenosis Is Diagnosed
Diagnosis begins with a thorough history and physical examination. The pattern of symptoms with standing and walking that improves with sitting is highly suggestive of stenosis. Your provider will assess your gait, lumbar range of motion, strength, sensation, and reflexes in your legs.
MRI of the lumbar spine is the imaging study of choice. It provides detailed images of the spinal canal, nerves, discs, and ligaments and can identify the location and severity of narrowing.
In patients who cannot undergo MRI, a CT scan with or without myelography can provide similar information.
Treatment Options
Initial treatment for lumbar spinal stenosis focuses on conservative measures. Physical therapy emphasizing flexion-based exercises, core strengthening, and aerobic conditioning can help manage symptoms. Activity modification, anti-inflammatory medications, and assistive devices such as a rolling walker may also be beneficial.
If symptoms persist, lumbar epidural steroid injections may provide temporary relief by reducing inflammation around the compressed nerves. [Internal link: Learn more about epidural steroid injections]
Surgery is considered when conservative treatment fails to adequately control symptoms and quality of life is significantly affected. The most common surgical procedure is lumbar laminectomy, also called decompression surgery, which removes the bone and ligament compressing the nerves. If instability or spondylolisthesis is present, a spinal fusion may be performed at the same time to stabilize the spine. [Internal link: Learn more about lumbar laminectomy] [Internal link: Learn more about lumbar fusion]
What to Expect
Lumbar spinal stenosis is a slowly progressive condition in most patients. Conservative treatment can effectively manage symptoms for many people, particularly those with mild to moderate stenosis. Surgical decompression has a high success rate for improving walking tolerance and reducing leg symptoms, though some patients continue to have residual low back pain.
Schedule a Consultation
If you are experiencing leg pain or weakness with walking that improves when you sit, our spine specialists can help determine if lumbar spinal stenosis is the cause and discuss your treatment options. Contact our office to schedule an evaluation.