Diagnosis of Spinal Stenosis

Doctors use a variety of tools to diagnose spinal stenosis and rule out other conditions.

Medical and Family History

Your doctor will ask about your medical and family history. This helps to determine if an injury, aging, or an underlying condition is the cause of your symptoms. Some questions your doctor may ask:

• Where is the exact location of your pain, and does the pain radiate anywhere? (e.g., back, legs, feet)?
• Can you describe your symptoms (e.g., aching, burning, tingling)?
• When did your symptoms begin?

Physical Exam 

Your doctor will likely perform a physical exam, which may check:

• The limits of your ability to move.
• If you have pain or symptoms when you hyper-extend the spine (bend backwards) or if the pain improves when you bend forward.
• Neurological function, such as sensation, muscle strength, and reflexes in the arms and legs.
• Your balance.
• How you walk.

Imaging Tests

• X-rays only show bones and can help diagnose:
  • Calcification.
  • Disc and facet joint degeneration.
  • Inherited conditions.
  • Injury such as broken bones (fractures).
  • Spondylolisthesis.
  • Tumors.
• MRI (magnetic resonance imaging) uses energy from a powerful magnet to produce signals that create a series of images. These images or “slices” are analyzed by a computer to produce an image of the back and surrounding structures. MRI can help diagnose damage or disease of the spine and is particularly useful for imaging the soft tissues, such as the disks, ligaments, and nerve roots in and around the spine.
• Computerized tomography (CT) uses a scanner to take images of the back. The images are analyzed by a computer to create reconstructed images in any plane as well as three-dimensional (3‑D) views of the back. As with MRI, CT scans help diagnose problems with the spinal canal and the surrounding tissues. CT is especially useful for looking at the bony parts of the back to detect fractures or changes from osteoarthritis.

Imaging alone may not determine if your spinal stenosis requires treatment.

Treatment of Spinal Stenosis

Doctors treat spinal stenosis with different options such as nonsurgical treatments, medications, and surgical treatments.

Nonsurgical Treatments

• Physical therapy to maintain motion of the spine, strengthen abdominal and back muscles, and build endurance, all of which help stabilize the spine. You may be encouraged to try slowly progressive aerobic activity, such as swimming or using exercise bicycles. In addition, your physical therapist or health care provider may recommend home exercises.
• A brace to provide some support and help you regain mobility. This approach is sometimes used for people with weak abdominal muscles or older patients with age-related changes at several levels of the spine.

• Complementary and alternative treatments that may help relieve pain. Some examples include:
  • Manipulation of the spine and nearby tissues. Professionals use their hands to adjust and massage the spine and muscles.
  • Acupuncture, which is a Chinese practice that uses thin needles that may relieve pain in some patients. 

Medications

Your doctor may prescribe one or more of the following medications to help manage the pain and inflammation caused by spinal stenosis:

• Anti–inflammatory medications to help relieve inflammation and pain.
• Over-the-counter pain relievers taken by mouth or applied to the skin.
• Prescription pain relievers for severe or acute pain.
• Anti-inflammatory or numbing injections for pain that radiates or travels due to nerve compression or irritation.

Surgical Treatments

If, after trying nonsurgical treatments and medications, you still have symptoms, your doctor may recommend meeting with a surgeon to talk about surgery. However, doctors may recommend surgery right away if you have numbness or weakness that interferes with walking, impaired bowel or bladder function, or other neurological involvement.

The decision to have surgery depends on:

• How nonsurgical treatments have helped your symptoms.
• The amount of pain you feel.
• Other diseases and conditions you may have.
• Your overall health.

However, not everyone is a candidate for surgery, even if symptoms persist. In addition, your surgeon will review the risks and possible benefits of the surgery or procedure.

Surgeons can relieve pressure on the spinal cord and nerves, and restore spine alignment and health by performing surgery. Possible surgeries include:

• Laminectomy is a surgery that doctors perform to treat spinal stenosis by removing the bony spurs and the bone walls of the vertebrae. This helps to open up the spinal column and remove the pressure on the nerves. Doctors may perform a discectomy during a laminectomy. A discectomy involves removing part of the herniated disk to relieve pressure on the spinal cord or nerve root. A facetectomy involves removing part or all of a facet joint to relieve pressure.

• Spinal fusion is a surgery that helps treat age-related changes to the spine and spondylolisthesis by joining two or more vertebrae in the spine that have slipped from their normal position. During this procedure, the surgeon may remove the disk between the vertebrae and uses bone grafts or metal devices to secure bones together.
• Minimally invasive surgery is a type of surgery that uses smaller incisions than standard surgery. Minimally invasive surgery may cause less scarring and damage to nearby muscles and other tissues. It can lead to less pain and faster recovery after surgery.

Removing and repairing the areas of spine that are creating pressure usually helps decrease symptoms. Most people have less leg pain and can walk better after surgery. However, if nerves were badly damaged before surgery, there may be some remaining pain or numbness or no improvement. Also, the degenerative process may continue, and pain or limitation of activity may reappear after surgery.

Who Treats Spinal Stenosis?

Doctors who can provide treatment of spinal stenosis may be:

• Family or primary care doctors.
• Neurologists, who treat disorders and diseases of the spine, brain, and nerves.
• Neurosurgeons, who perform surgery for disorders and diseases of spine, brain, and nerves.
• Orthopaedists, who treat and perform surgery for bone and joint diseases.
• Pain specialists, who are physicians including anesthesiologists with specialized training in evaluation, diagnosis, and treatment of different types of pain.
• Physiatrists, who specialize in physical and rehabilitation medicine.
• Physical therapists, who specialize in movement and strengthening muscles.
• Rheumatologists, who specialize in treating musculoskeletal diseases and autoimmune disorders.