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If you find yourself stopping to rest because your legs feel heavy or leaning on a shopping cart to ease back pain at the market, you might assume these are unavoidable signs of aging. It doesn’t have to be that way.
In my practice, I talk with many patients who believe that chronic back and leg pain are just symptoms of aging. That stubborn discomfort can instead be a sign of a treatable condition called spinal stenosis.
Stenosis is a medical term that means “narrowing.” The bones that make up your spine (vertebrae) have a space in the middle where the spinal cord’s nerves pass through. When this space narrows, the nerves inside the vertebrae have less room to work, leading to pain or numbness.
While spinal stenosis is most common in people over 50, younger people can develop stenosis too. And for most patients, having it doesn’t mean you have to quit the activities you love. Spine care experts at MedStar Health can help you feel better without surgery.
What causes spinal stenosis?
For most people, stenosis is a slow process that results from “wear and tear.” The most common causes include:
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Anatomy: Some people are born with spine conditions or irregularities.
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Arthritis: Osteoarthritis, a degenerative joint disease, can lead to disk degeneration and enlargement or overgrowth of bone. Rheumatoid arthritis is a chronic inflammatory disease that can sometimes cause problems with the joints in the spine that lead to stenosis.
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Thickened ligaments: These bands that hold the spine together can get stiff and bulge, crowding nerve space.
Factors that can increase your risk include genetics, smoking, obesity, and past injuries to the spine.
Spinal stenosis can happen in any part of the back:
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Lumbar stenosis: The most common form, affecting about 11% of adults in the U.S., lumbar stenosis impacts the lower back. It’s more common in people older than 50.
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Cervical stenosis: Narrowing in the neck.
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Thoracic stenosis: Narrowing in the middle of the back is less common.
What are the symptoms of spinal stenosis?
Spinal stenosis doesn’t usually feel like a sharp injury to the back. Instead, it often seems like a collection of uncomfortable sensations that get worse with activity. Classic symptoms of spinal stenosis include:
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Neurogenic claudication: A hallmark of lumbar stenosis, claudication feels like cramping, weakness, or heaviness in the legs. It begins when you stand or walk but goes away upon sitting.
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Numbness or tingling: A feeling of “pins and needles” in the feet or hands.
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Sciatica: This shooting pain that travels from the lower back down through the leg is a common sign.
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Relief when bending forward: Known as the “shopping cart sign,” leaning forward can open the narrowed channel in the spinal column, making more room for the nerves. room. Many patients experience this in the supermarket, when leaning on the cart gives their nerves a temporary break.
Seek emergency medical care if you have symptoms such as tripping because you can’t lift the front of your foot (drop foot), sudden weakness or difficulty performing basic movements, or loss of control of your bowel or bladder function. These can be signs of serious sudden nerve compression or damage, or even underlying conditions such as a stroke or a tumor.
Related: Read "What’s Causing My Back Pain, and How Can I Treat It?"
Exams and imaging to diagnose spinal stenosis.
In my practice, diagnosing spinal stenosis starts with a conversation. When someone tells me their back pain goes away when they sit, that’s a big indicator of spinal stenosis. Next, I ask patients to move and bend to see how the nerves react, which often tells us which part of your spine is impacted.
To confirm the diagnosis and learn the degree of narrowing, we use imaging including:
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X-rays to check the alignment of bones and look for signs of instability and aging
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MRI, which enables us to get a detailed view of the soft tissues, ligaments, and nerves
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CT scan to provide a very detailed image of the spine
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Myelogram, in which we use a special dye to color the nerves and determine if they are being squeezed by narrowing, especially for patients that cannot have an MRI.
Just because imaging shows stenosis, that doesn’t necessarily mean you need surgery.
Does spinal stenosis require surgery?
Most patients do not need surgery to get significant pain relief—even those with significant narrowing on imaging scans. Some non-surgical options include:
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Physical therapy: MedStar Health’s expert physical therapists teach exercises to strengthen the core muscles that support the spine.
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Steroid injections: Epidural steroid injections can reduce inflammation around a crowded nerve, relieving pain for months at a time.
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Weight loss: Extra weight can put additional stress on the lower back. Even modest weight loss can reduce the pressure on the nerves.
Related: Read "How Physical Therapy Can Help Relieve or Prevent Back Pain."
When is surgery necessary?
If conservative treatments don’t provide enough relief, it’s time to consider surgical options. MedStar Health surgeons tailor procedures to each specific patient’s anatomy and condition.
Among our most impactful approaches is minimally invasive spine surgery (MISS). Our surgeons are fellowship-trained and highly experienced at these procedures that use computer-assisted technologies to perform precise surgery to help relieve stenosis in some patients.
MISS has several powerful benefits, including minimizing the damage to surrounding tissues. Compared to traditional surgery, MISS offers:
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Faster recovery and return to activities
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Reduced risk of infection and blood loss
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Smaller incisions
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Less scarring
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Better range of motion
For some patients, traditional open surgery is the best approach. Our providers work with patients to determine the most effective treatment strategy to reach their unique goals.
Related: Read "Researchers Investigate Novel Bone-Fusing Procedure that Could Revolutionize Spine Surgery."
Multidisciplinary care at MedStar Health.
One hallmark of exceptional care here is our team approach to care. This means we can collaborate to offer:
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Direct specialist access: Your surgeon works directly with radiologists to discuss the nuances of your imaging and coordinates non-surgical treatment plans with pain management specialists.
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Full-circle rehab: If surgery is required, you have direct access to the MedStar Health Physical Therapy and MedStar National Rehabilitation Hospital to rebuild your strength and flexibility.
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Continuous care: From your first scan to your final therapy session, your team stays connected to ensure you recover well and quickly.
When leg and back pain force you to cancel plans or change your schedule, don’t wait. There are many effective, conservative treatments that can help you get back to walking and shopping without being sidelined by pain. Talk with your doctor or a specialist if it’s impacting your life.
