Diagnosis

To diagnose spinal stenosis, your healthcare professional will likely ask about your symptoms and medical history. You may have a physical exam, and you might need imaging tests.

Imaging tests

These tests may include:

  • X-rays. An X-ray of the back can show bone changes that may be making the open space within the spinal canal smaller.
  • Magnetic resonance imaging (MRI). An MRI uses a powerful magnet and radio waves to make detailed images of hard and soft tissue. The test can show damage to the disks and ligaments in the spine. It also can show whether tumors are present.
  • Computerized tomography (CT). If you can't have an MRI, you may need a CT scan. This test combines X-ray images taken from many different angles. In a CT myelogram, contrast material is placed into the spinal canal. The contrast material can help the healthcare team find herniated disks, bone spurs and tumors on the images.

Treatment

Depending on symptoms, treatment for spinal stenosis may include medicines, physical therapy and surgery.

Medicines

Medicines that can be helpful for spinal stenosis include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). If pain relievers you can buy without a prescription don't offer enough relief, prescription NSAIDs might be helpful.
  • Antidepressants. Nightly doses of tricyclic antidepressants, such as amitriptyline, can help ease chronic pain.
  • Anti-seizure medicine. Some anti-seizure medicines, such as gabapentin (Neurontin, Gralise, others), are used to ease pain caused by damaged nerves.
  • Opioids. Opioid medicines such as oxycodone (Oxycontin, Roxicodone, others) should be used sparingly. They can be habit-forming.

Steroid shots

Nerve roots may become irritated and swollen where they are being pinched due to spinal stenosis. Sometimes a steroid medicine is put into the space around a pinched nerve to ease swelling and pain.

But steroid shots might not be the best choice for spinal stenosis. Some studies have shown that combined shots of steroids and a numbing medicine ease back pain no better than shots of numbing medicine alone.

This is important because steroids occasionally can cause serious side effects, and there is a limit to how much steroid medicine you can get. That's why there's often a waiting period of many months between steroid shots.

Physical therapy

Physical therapy involves exercises that may help:

  • Build strength and endurance.
  • Keep the spine flexible and stable.
  • Improve balance.

Surgery

Surgeries that can make more space within the spinal canal include:

  • Laminectomy. This surgery takes out the back part of a spinal bone. That part of the bone is called the lamina. The surgery eases pressure on the nerves by making more space around them. Sometimes, the bone may need to be linked to nearby spinal bones with metal hardware and a bone graft in a fusion procedure.
  • Laminotomy. This surgery takes out only part of the lamina. The surgeon makes a hole just big enough to ease pressure in a specific spot.
  • Laminoplasty. This surgery is done on the spinal bones in the neck. It makes the space within the spinal canal bigger by putting a hinge on the lamina. Metal hardware is used to bridge the gap in the open part of the spine.

These surgeries often help ease spinal stenosis symptoms. But sometimes symptoms stay the same or get worse after surgery. Surgical risks include:

  • Infection.
  • Blood clot in a leg vein.
  • A tear in the membrane that covers the spinal cord.

Lifestyle and home remedies

Your healthcare professional may suggest:

  • Pain relievers. Medicines you can buy without a prescription may help ease pain and swelling. These medicines include aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) and acetaminophen (Tylenol, others).
  • Weight loss. Losing extra weight may ease pain by taking some stress off the lower back.
  • Exercise. Stretching and strengthening exercises may help ease symptoms. Talk with your healthcare team about exercises that are safe to do at home.
  • Walking aids. Using a cane or walker can help with stability. This also may ease pain by allowing you to bend forward while walking.

Alternative medicine

Integrative medicine and alternative therapies may be used with other treatments to help you cope with spinal stenosis pain. Examples include:

  • Acupuncture.
  • Massage therapy.
  • Chiropractic treatment.

Preparing for your appointment

You're likely to start by seeing your primary healthcare professional. But you might be referred to a doctor who specializes in conditions that affect the nervous system. Depending on how serious your symptoms are, you also may need to see a surgeon who specializes in spinal surgery. That surgeon may be a neurosurgeon or an orthopedic surgeon.

What you can do

When you make the appointment, ask if there's anything you need to do before your appointment, such as not eating or drinking for a certain amount of time. Make a list of:

  • Your symptoms, including any that don't seem related to the reason for your appointment.
  • Key personal information, including major stresses, recent life changes and family medical history.
  • All medicines, vitamins or other supplements you take, including the doses.
  • Questions to ask your healthcare professional.

Take a family member or friend along, if possible, to help you remember the information you're given.

For spinal stenosis, some basic questions to ask your healthcare professional include:

  • What is the most likely cause of my symptoms?
  • What tests do I need?
  • What treatment do you recommend?
  • If you're recommending medicines, what are the possible side effects?
  • I have other medical conditions. How can I best manage them together?
  • How long will I need treatment?
  • What self-care measures should I try?

What to expect from your doctor

Your healthcare professional may ask you questions, including:

  • When did your symptoms start?
  • Have the symptoms gotten worse over time?
  • Do you have pain? Where is it?
  • Does any position ease the pain or make it worse?
  • Do you have any weakness, numbness or tingling?
  • Do you feel clumsier lately?
  • Have you had any bowel or bladder changes?
  • Have your parents or siblings ever had similar symptoms?
  • What spine surgeries, shots or other treatment have you had before?
By Mayo Clinic Staff