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Lumbar Spinal Canal Stenosis: A Common Cause of Back and Leg Pain
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Am Fam Physician. 1998 Apr 15;57(8):1839-1840.
See related article on lumbar spine stenosis.
What is lumbar spinal canal stenosis?
Lumbar spinal canal stenosis is a narrowing in the space in the lower spine that carries nerves to your legs. This space is very small. It gets even smaller if the bone and tissue around it grow. It takes many years for this bone and tissue to grow.
Arthritis, falls, accidents and wear and tear on the bones and joints in the spine also play a part in stenosis. As the lumbar spinal canal shrinks, the nerves that go through it are squeezed. This squeezing may cause back pain, leg pain and leg weakness. Many adults have this kind of stenosis.
How does my doctor know I have stenosis in my spine?
People with stenosis usually have back pain most of the time. They also may have leg pain, numbness or weakness. The leg pain and numbness usually start when you stand up and begin to walk or exercise. The leg pain has been described as a burning or prickly feeling that may start in the buttocks and spread down to the feet when you start walking.
Your legs might also feel cramped, tired or weak. These leg symptoms are a condition called neural claudication of the legs. If you have lumbar canal stenosis, the neural leg claudication starts when you stand up, gets worse when you walk and gets better when you stop walking.
Often, the leg pain gets better if you crouch down or lie down in a fetal position (on your sides with your knees tucked up to your chest). It's believed that these positions “open” the lumbar canal and take the pressure off the nerves that go to the legs.
Leg claudication starts slowly but gets worse after a while. The leg pain begins slowly and gets worse with activity. Your doctor can probably tell if you have claudication just by asking you certain questions. Sometimes, though, special tests and x-rays of the spine are needed.
Is this the same thing as a ruptured disc?
Lumbar canal stenosis is not the same thing as a ruptured disc. A ruptured (or herniated) disc usually pinches one or two nerves at a time. The pain caused by a pinched nerve in the lumbar spine is usually easy to diagnose. This pain has a special name: sciatica.
Sciatica usually causes back pain that shoots down one leg. This pain can happen any time, not just when you stand up or start walking.
What can I do for the pain and numbness?
Once you know you have lumbar canal stenosis or claudication, you have several choices for treatment, depending on how bad your symptoms are. If your pain is mild and you haven't had it for very long, you can try an exercise program or a physical therapy program, to strengthen your back muscles and improve your posture. Your doctor may also prescribe medicine for inflammation in your back bone.
If you have severe back pain and claudication, however, you may need to see a spine surgeon. This doctor may recommend surgery to take the pressure off the nerves in your lower spine. The surgery is called a laminectomy (say: lam-in-ek-toe-me), since parts of your spine called the lamina are taken out to make room for the nerves in the spinal canal. This surgery is safe and works well for most people.
This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
Copyright © 1998 by the American Academy of Family Physicians.
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