Lumbar spinal stenosis is narrowing of the spinal canal from arthritis, disc bulging and thick ligaments, which squeezes the nerve roots in older adults. It typically causes leg pain with standing and walking that eases when sitting or leaning forward.
Key symptoms
- Pain, numbness or heaviness in the buttocks and legs with walking or standing (neurogenic claudication)
- Relief when sitting or bending forward, such as leaning on a shopping cart
- Low back pain
- Shorter and shorter walking distance
What you find on exam
- Neurologic exam often normal at rest
- Gait, balance, leg strength, sensation and reflexes
- Foot pulses to rule out vascular claudication
- Pain with standing back extension
Tests
- MRI of the lumbar spine to confirm the narrowing
- CT myelogram if MRI cannot be done
- Ankle-brachial index if foot pulses are weak
Treatment basics
- Physical therapy with flexion-based exercise and a walking program
- Acetaminophen or NSAIDs for pain
- Epidural steroid injection for short-term relief
- Decompression surgery (laminectomy) for severe or progressive symptoms
Red flags
- Saddle numbness, urine retention or loss of bowel control
- Progressive leg weakness
- Fever, weight loss or a cancer history with back pain
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.