Signs and Symptoms
Lumbar (lower back) stenosis commonly causes:
- Pain, cramping, heaviness or tingling in the buttocks and legs when standing or walking (neurogenic claudication)
- Relief when you sit down, bend forward or lean on a shopping cart
- Low back ache and stiffness
- Leg weakness or balance problems in more advanced cases
Cervical (neck) stenosis can cause neck pain, arm numbness, clumsy hands, or trouble with balance and walking. Hand clumsiness and balance changes deserve prompt evaluation.
What Causes It?
Spinal stenosis develops gradually, most often after age 50. Arthritis leads to bone spurs, thickening of the ligaments inside the spinal canal, enlargement of the facet joints and bulging of worn discs. Together these crowd the space where nerves travel. A vertebra slipping forward (spondylolisthesis), a prior spine injury or surgery, and a naturally narrow canal can also contribute.
How We Diagnose It at POPB
Dr. Baskin reviews how far you can walk, what positions relieve your symptoms, and your medical history. He examines your strength, reflexes, sensation and balance, and checks leg circulation, since poor blood flow can cause similar leg symptoms when walking.
X-rays in our office show arthritis and alignment. An MRI, also available on site, shows how much the nerves are compressed and helps plan any injection.
Non-Surgical Treatment Options
Non-surgical care aims to improve walking tolerance and reduce pain:
- Physical therapy in our office, emphasizing flexion-based exercises, core and hip strength, balance and walking endurance. Therapists share your chart with Dr. Baskin.
- Stationary cycling or walking with a slight forward lean, which many people with stenosis tolerate better
- Medications to manage pain when appropriate
- Epidural steroid injections, performed by Dr. Baskin under fluoroscopy in our in-office procedure room, to reduce nerve inflammation
- Facet joint injections or radiofrequency ablation when arthritic facet joints contribute to back pain
Surgical Options
When symptoms seriously limit walking or daily life despite non-surgical care, or when weakness is progressing, surgery to create more room for the nerves (decompression, such as laminectomy) may be an option. Dr. Baskin does not perform spine surgery, but he will refer you to a spine surgeon and share your imaging and records. For some patients with chronic pain, he also offers advanced neuromodulation (spinal cord stimulation).
Recovery
Spinal stenosis is a long-term condition, and the goal is managing symptoms so you can stay active. Many people improve their walking distance with a few weeks to a few months of therapy and a regular home program. Relief from an epidural injection usually begins within several days and lasts a variable amount of time; some people repeat injections when symptoms return. Results vary.
Insurance and Cost
Medicare and most commercial PPO plans generally cover evaluation, imaging, physical therapy and spinal injections when medically necessary. Prior authorization is often required for MRI, epidural injections and radiofrequency ablation, and some plans require therapy first. HMO and managed-care plans need a referral in our office before your visit. Our staff verify benefits when you call.
When to Be Seen
Call our office if leg pain or heaviness is limiting how far you can walk, if you notice balance problems or hand clumsiness, or if symptoms are gradually getting worse.
Go to the emergency room or call 911 for loss of bladder or bowel control, saddle numbness (numbness in the groin, inner thighs or buttocks), rapidly worsening leg weakness, fever with back pain, or back pain after major trauma.
