What is lumbar spinal stenosis?
Lumbar spinal stenosis is a narrowing of the spaces available for the nerves in the lower back. It most commonly develops from age-related changes such as disc degeneration, arthritis and bone spurs, and thickening of the surrounding ligaments.
As the space becomes tighter, the nerves can become compressed, causing leg pain, numbness, tingling, heaviness, or weakness, particularly with standing or walking. Symptoms often improve with sitting or leaning forward.
Symptoms
The pattern is usually more telling than the pain itself:
- Leg pain, heaviness, or burning that builds the longer you stand or walk
- Relief within a minute or two of sitting, or of leaning on a cart or counter
- Walking distance that has shrunk over months or years
- Numbness or tingling in both legs, often worse than the back pain itself
- Weakness in the legs
- Bowel/bladder disturbances
- Back pain that may be mild, or absent entirely
Urgent
Seek urgent care for new loss of bowel or bladder control, numbness in the saddle area, or rapidly worsening weakness in both legs.
How it is diagnosed
The story does most of the work: what distance brings symptoms on, and what relieves them. Examination checks strength, sensation, reflexes, and balance. MRI shows where the canal is narrowed and which nerves are involved. Because narrowing is common on imaging in people with no symptoms at all, the scan is interpreted against the examination rather than on its own.
Non-surgical treatment
Most people with stenosis are managed without an operation. Physical therapy aimed at posture, core strength, and walking tolerance often helps more than rest. Anti-inflammatory medication may be appropriate, and an epidural steroid injection can settle nerve irritation enough to make therapy productive. Activity is adjusted rather than abandoned, a stationary bicycle is frequently tolerated when walking is not.
When surgery is considered
Decompression is discussed when walking tolerance has become limiting despite reasonable non-operative care, or when strength is declining. The goal is to make room for the nerves while preserving as much healthy anatomy as possible; tubular or endoscopic approaches may be options depending on the pattern of narrowing. Fusion is added only when there is instability or deformity, not routinely.