Spinal Stenosis Symptoms: Back and Leg Pain With Walking, and When to Be Seen

What it involves

MedlinePlus explains that spinal stenosis is a narrowing of the spine that puts pressure on the nerves and spinal cord and can cause pain. The encyclopedia describes it as narrowing of the spinal column that presses on the cord, or narrowing of the openings where the spinal nerves exit. It mostly affects people older than 50, though a spine injury or a naturally narrow canal can cause it in younger people.

Who this is for

• Adults over 50 with back pain and leg cramping, numbness or weakness when walking.
• Patients whose symptoms ease when they sit or lean forward.
• People with arthritis or a past back injury who have new nerve symptoms.
• Anyone who cannot walk as far as they used to because of leg or back discomfort.

What to expect

• Questions about where the pain is, what position helps, how far you can walk and any weakness or balance trouble
• An exam of strength, reflexes, sensation, balance and movement of the back
• A referral for spine MRI, CT or X-ray if your provider recommends imaging, since the practice does not list those services
• A plan for pain relief and daily activity, and a referral to spine care if symptoms warrant it

What causes the narrowing

The encyclopedia says spinal stenosis is mostly age-related. Disks dry out and bulge, and the bones and ligaments of the spine thicken, often from arthritis or long-term swelling. Some people are born with less room for the spinal cord. MedlinePlus also lists Paget disease, a herniated disk, spinal injury, tumors and fractures. Arthritis and scoliosis are named as diseases that can cause it. The osteoarthritis guide describes the joint changes that often sit behind it.

The pattern of symptoms

According to the encyclopedia, symptoms usually worsen slowly and often affect one side of the body, though both legs can be involved. People notice numbness, cramping or pain in the back, buttocks, thighs or calves, or in the neck, shoulders and arms, and weakness in part of a leg or arm. The key detail is that symptoms typically worsen with standing or walking and ease with sitting or leaning forward. The leg pain when walking guide compares this with artery causes.

How it is sorted out

A provider checks where the pain is and how it limits movement. MedlinePlus says you may be asked to walk on your toes and heels, bend in different directions and lie down while a straight leg is lifted, and that strength, reflexes, sensation and balance are tested. Imaging such as spine MRI, CT or X-ray, and electromyography, are the tests the encyclopedia lists. The practice does not perform them, so they are arranged by referral. The sciatica guide covers a related nerve pattern.

Treatment without surgery first

MedlinePlus says nonsurgical care is the first step. That can include physical therapy for stretching and strengthening, cold or heat packs during flare-ups, medicines for back pain and epidural injections of medicine around the nerves. Cognitive behavioral therapy may help with coping. Physical therapy and spinal injections are arranged by referral, since the practice lists joint injections but does not list spinal injections. The low back pain guide describes common first steps at home and at a visit.

When surgery is considered

The encyclopedia says surgery is considered if pain does not respond to treatment or if movement or feeling is lost, and that the decision is made jointly with a provider. Options include removing a bulging disk, removing part of a vertebra or widening the spinal canal and nerve openings, sometimes with spinal fusion. MedlinePlus notes that outcomes are hard to predict and that back surgery is not always the right choice, so a spine surgeon discusses the risks and benefits after referral.

Signs that need prompt attention

MedlinePlus advises contacting a provider for any symptoms of spinal stenosis. It also lists signs that call for prompt attention: difficulty or poor balance when walking, worsening numbness or weakness in a limb, and problems controlling urination or bowel movements. Losing control of the bladder or bowel, or numbness around the groin with leg weakness, should be treated as an emergency, so go to the nearest emergency room. Do not wait for a routine appointment.

Sources

• MedlinePlus: Spinal Stenosis (health topic)
• MedlinePlus: Spinal stenosis (encyclopedia)