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August 2016

Questions and Answers about

Spinal Stenosis

This publication contains general information

about spinal stenosis. It describes the

condition's causes, symptoms, diagnosis, and

treatments. At the end is a list of additional

resources. If you have further questions after

reading this publication, you may wish to

discuss them with your doctor.

What Is Spinal Stenosis?

Spinal stenosis is a narrowing of spaces in

the spine (backbone) that results in pressure

on the spinal cord and/or nerve roots. This

disorder usually involves the narrowing of

one or more of three areas of the spine:

the canal in the center of the column

of bones (vertebral or spinal column)

through which the spinal cord and

nerve roots run,

1. 

the canals at the base or roots of

nerves branching out from the spinal

cord, or

2. 

the openings between vertebrae

(bones of the spine) through which

nerves leave the spine and go to

other parts of the body.

3. 

Who Gets Spinal Stenosis?

What Structures of the Spine Are

Involved?

What Causes Spinal Stenosis?

What Are the Symptoms of Spinal

Stenosis?

How Is Spinal Stenosis Diagnosed?

Who Treats Spinal Stenosis?

What Are Some Nonsurgical

Treatments for Spinal Stenosis?

What Are Some Alternative Therapies

for Spinal Stenosis?

We want to hear from you 

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When Should Surgery Be Considered

and What Is Involved?

What Are the Major Risks of Surgery?

What Are the Long-Term Outcomes of

Surgical Treatment for Spinal

Stenosis?

What Research Is Being Conducted

on Spinal Stenosis?

What Can People Find More

Information About Spinal Stenosis?

Illustrations

Figure 1. Side View of Spine

Figure 2. Structures of the Spine

Figure 3. Section of the Spine

Figure 4. Normal Vertebra (Cross

Section)

Figure 5. Small Spinal Canal

Figure 6. Herniated Disk

Figure 7. Side View of Spine and Side

View of Spine (Cross Section)

Questions and Answers About Spinal Stenosis https://www.niams.nih.gov/health_info/spinal_stenosis/

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Figure 2

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Who Gets Spinal Stenosis?

This disorder is most common in men and

women over 50 years of age. However, it may

occur in younger people who are born with a

narrowing of the spinal canal or who suffer an

injury to the spine.

What Structures of the Spine Are

Involved?

The spine is a column of 26 bones that

extend in a line from the base of the skull to

the pelvis (see fig. 1). Twenty-four of the

bones are called vertebrae. The bones of the

spine include 7 cervical vertebrae in the

neck; 12 thoracic vertebrae at the back wall

of the chest; 5 lumbar vertebrae at the inward

curve (small) of the lower back; the sacrum,

composed of 5 fused vertebrae between the

hip bones; and the coccyx, composed of 3 to

5 fused bones at the lower tip of the vertebral

column.

The vertebrae link to each other and are

cushioned by shock-absorbing disks that lie

between them. Other structures of the spine

include:

Facet joints. Joints located on the

back of the main part of the vertebra.

They are formed by a portion of one

vertebra and the vertebra above it.

They connect the vertebrae to each

other and permit backward motion.

Ligaments. Elastic bands of tissue

that support the spine by preventing

the vertebrae from slipping out of line

as the spine moves.

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Spinal cord/nerve roots. A major

part of the central nervous system

that extends from the base of the

brain down to the lower back and that

is encased by the vertebral column. It

consists of nerve cells and bundles of

nerves. The cord connects the brain

to all parts of the body via 31 pairs of

nerves that branch out from the cord

and leave the spine between

vertebrae.

Cauda equina. A sack of nerve roots

that continues from the lumbar region,

where the spinal cord ends, and

continues down to provide neurologic

function to the lower part of the body.

It resembles a “horse’s tail” (cauda

equina in Latin).

What Causes Spinal Stenosis?

The normal vertebral canal (see fig. 4)

provides adequate room for the spinal cord

and cauda equina. Narrowing of the canal,

which occurs in spinal stenosis, may be

inherited or acquired. Some people inherit a

small spinal canal (see fig. 5) or have a

curvature of the spine (scoliosis) that

produces pressure on nerves and soft tissue

and compresses or stretches ligaments. In an

inherited condition called achondroplasia,

defective bone formation results in changes

that reduce the diameter (distance across) of

the spinal canal.

Acquired conditions that can cause spinal

stenosis are explained in more detail in the

sections that follow.

Questions and Answers About Spinal Stenosis https://www.niams.nih.gov/health_info/spinal_stenosis/

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Degenerative Conditions

Spinal stenosis most often results from a

gradual, degenerative aging process. Either

structural changes or inflammation can begin

the process. As people age, the ligaments of

the spine may thicken and calcify (harden

from deposits of calcium salts). Bones and

joints may also enlarge: when surfaces of the

bone begin to project out from the body,

these projections are called osteophytes

(bone spurs).

When the health of one part of the spine fails,

it usually places increased stress on other

parts of the spine. For example, a herniated

(bulging) disk may place pressure on the

spinal cord or nerve root (see fig. 6). When a

segment of the spine becomes too mobile,

the capsules (enclosing membranes) of the

facet joints thicken in an effort to stabilize the

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segment, and bone spurs may occur. This

decreases the space available for nerve roots

leaving the spinal cord.

Spondylolisthesis, a condition in which one

vertebra slips forward on another, may result

from a degenerative condition or an accident,

or, very rarely, may be acquired at birth. Poor

alignment of the spinal column when a

vertebra slips forward onto the one below it

can place pressure on the spinal cord or

nerve roots at that place.

Aging with secondary changes is the most

common cause of spinal stenosis. Two forms

of arthritis that may affect the spine are

osteoarthritis and rheumatoid arthritis.

Osteoarthritis. Osteoarthritis is the

most common form of arthritis and is

more likely to occur in middle-aged

and older people. It is a chronic,

degenerative process that may

involve multiple joints of the body. It

wears away the surface cartilage

layer of joints, and is often

accompanied by overgrowth of bone,

formation of bone spurs, and impaired

function. If the degenerative process

of osteoarthritis affects the facet

joint(s) and the disk, the condition is

sometimes referred to as spondylosis.

This condition may be accompanied

by disk degeneration, and an

enlargement or overgrowth of bone

that narrows the central and nerve

root canals.

Rheumatoid Arthritis. Rheumatoid

arthritis usually affects people at an

earlier age than osteoarthritis does

and is associated with inflammation

and enlargement of the soft tissues

(the synovium) of the joints. Although

not a common cause of spinal

stenosis, damage to ligaments,

bones, and joints that begins as

synovitis (inflammation of the synovial

membrane that lines the inside of the

joint) has a severe and disrupting

effect on joint function. The portions

of the vertebral column with the

greatest mobility (for example, the

neck area) are often the ones most

affected in people with rheumatoid

arthritis.

Other Acquired Conditions

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The following conditions that are not related

to degenerative disease are causes of

acquired spinal stenosis:

Tumors of the spine are abnormal

growths of soft tissue that may affect

the spinal canal directly by

inflammation or by growth of tissue

into the canal. Tissue growth may

lead to bone resorption (bone loss

due to overactivity of certain bone

cells) or displacement of bone.

Trauma (accidents) may either

dislocate the spine and the spinal

canal or cause burst fractures that

produce fragments of bone that

penetrate the canal.

Paget's disease of bone is a

chronic (long-term) disorder that

typically results in enlarged and

abnormal bones. Excessive bone

breakdown and formation cause thick

and fragile bone. As a result, bone

pain, arthritis, noticeable bone

structure changes, and fractures can

occur. The disease can affect any

bone of the body, but is often found in

the spine. The blood supply that

feeds healthy nerve tissue may be

diverted to the area of involved bone.

Also, structural problems of the

involved vertebrae can cause

narrowing of the spinal canal,

producing a variety of neurological

symptoms. Other developmental

conditions may also result in spinal

stenosis.

Ossification of the posterior

longitudinal ligament occurs when

calcium deposits form on the ligament

that runs up and down behind the

spine and inside the spinal canal (see

fig. 7). These deposits turn the fibrous

tissue of the ligament into bone.

(Ossification means "forming bone.")

These deposits may press on the

nerves in the spinal canal.

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What Are the Symptoms of Spinal

Stenosis?

The space within the spinal canal may

narrow without producing any symptoms.

However, if narrowing places pressure on the

spinal cord, cauda equina, or nerve roots,

there may be a slow onset and progression of

symptoms. The neck or back may or may not

hurt. More often, people experience

numbness, weakness, cramping, or general

pain in the arms or legs. If the narrowed

space within the spine is pushing on a nerve

root, people may feel pain radiating down the

leg (sciatica). Sitting or flexing the lower back

should relieve symptoms. (The flexed position

"opens up" the spinal column, enlarging the

spaces between vertebrae at the back of the

spine.) Flexing exercises are often advised,

along with stretching and strengthening

exercises.

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People with more severe stenosis may have

problems with bowel and bladder function

and foot disorders. For example, cauda

equina syndrome is a severe, and very rare,

form of spinal stenosis. It occurs because of

compression of the cauda equina, and

symptoms may include loss of control of the

bowel, bladder, or sexual function and/or

pain, weakness, or loss of feeling in one or

both legs. Cauda equina syndrome is a

serious condition requiring urgent medical

attention.

How Is Spinal Stenosis Diagnosed?

The doctor may use a variety of approaches

to diagnose spinal stenosis and rule out other

conditions.

Medical history. The patient tells the

doctor details about symptoms and

about any injury, condition, or general

health problem that might be causing

the symptoms.

Physical examination. The doctor

(1) examines the patient to determine

the extent of limitation of movement,

(2) checks for pain or symptoms when

the patient hyper-extends the spine

(bends backwards), and (3) checks

for normal neurologic function (for

instance, sensation, muscle strength,

and reflexes) in the arms and legs.

X-ray. An x-ray beam is passed

through the back to produce a

two-dimensional picture. An x-ray may

be done before other tests to look for

signs of an injury, tumor, or inherited

problem. This test can show the

structure of the vertebrae and the

outlines of joints, and can detect

calcification.

MRI magnetic resonance imaging).

Energy from a powerful magnet

(rather than x-rays) produces signals

that are detected by a scanner and

analyzed by computer. This produces

a series of cross-sectional images

("slices") and/or a three-dimensional

view of parts of the back. An MRI is

particularly sensitive for detecting

damage or disease of soft tissues,

such as the disks between vertebrae

or ligaments. It shows the spinal cord,

nerve roots, and surrounding spaces,

as well as enlargement, degeneration,

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or tumors.

Computerized axial tomography

(CAT). X-rays are passed through the

back at different angles, detected by

a scanner, and analyzed by a

computer. This produces a series of

cross-sectional images and/or threedimensional views of the parts of the

back. The scan shows the shape and

size of the spinal canal, its contents,

and structures surrounding it.

Myelogram. A liquid dye that x-rays

cannot penetrate is injected into the

spinal column. The dye circulates

around the spinal cord and spinal

nerves, which appear as white

objects against bone on an x-ray film.

A myelogram can show pressure on

the spinal cord or nerves from

herniated disks, bone spurs, or

tumors.

Who Treats Spinal Stenosis?

Nonsurgical treatment of spinal stenosis may

be provided by internists or general

practitioners. The disorder is also treated by

specialists such as rheumatologists, who

treat arthritis and related disorders; and

neurologists, who treat nerve diseases.

Orthopaedic surgeons and neurosurgeons

also provide nonsurgical treatment and

perform spinal surgery if it is required. Allied

health professionals such as physical

therapists may also help treat patients.

What Are Some Nonsurgical

Treatments for Spinal Stenosis?

In the absence of severe or progressive

nerve involvement, a doctor may prescribe

one or more of the following conservative

treatments:

Nonsteroidal anti–inflammatory drugs

(NSAIDs), such as aspirin, naproxen,

ibuprofen, or indomethacin, to reduce

inflammation and relieve pain.1,2

Analgesics, such as acetaminophen,

to relieve pain.

Corticosteroid injections into the

outermost of the membranes covering

the spinal cord and nerve roots to

reduce inflammation and treat acute

pain that radiates to the hips or down

a leg.

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Anesthetic injections, known as nerve

blocks, near the affected nerve to

temporarily relieve pain.

Restricted activity (varies depending

on extent of nerve involvement).

Prescribed exercises and/or physical

therapy to maintain motion of the

spine, strengthen abdominal and back

muscles, and build endurance, all of

which help stabilize the spine. Some

patients may be encouraged to try

slowly progressive aerobic activity

such as swimming or using exercise

bicycles.

A lumbar brace or corset to provide

some support and help the patient

regain mobility. This approach is

sometimes used for patients with

weak abdominal muscles or older

patients with degeneration at several

levels of the spine.

1 All medicines can have side effects. Some

medicines and side effects are mentioned in

this publication. Some side effects may be

more severe than others. You should review

the package insert that comes with your

medicine and ask your health care provider

or pharmacist if you have any questions

about the possible side effects.

2 Warning: Side effects of NSAIDs include

stomach problems; skin rashes; high blood

pressure; fluid retention; and liver, kidney,

and heart problems. The longer a person

uses NSAIDs, the more likely he or she is to

have side effects, ranging from mild to

serious. Many other drugs cannot be taken

when a patient is being treated with NSAIDs,

because NSAIDs alter the way the body uses

or eliminates these other drugs. Check with

your health care provider or pharmacist

before you take NSAIDs. NSAIDs should only

be used at the lowest dose possible for the

shortest time needed.

What Are Some Alternative

Therapies for Spinal Stenosis?

Alternative (or complementary) therapies are

diverse medical and health care systems,

practices, and products that are not presently

considered to be part of conventional

medicine. Some examples of these therapies

used to treat spinal stenosis follow:

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Chiropractic treatment. This

treatment is based on the philosophy

that restricted movement in the spine

reduces proper function and may

cause pain. Chiropractors may

manipulate (adjust) the spine to

restore normal spinal movement.

They may also employ traction, a

pulling force, to help increase space

between the vertebrae and reduce

pressure on affected nerves. Some

people report that they benefit from

chiropractic care. Research thus far

has shown that chiropractic treatment

is about as effective as conventional,

nonoperative treatments for acute

back pain.

Acupuncture. This treatment

involves stimulating certain places on

the skin by a variety of techniques, in

most cases by manipulating thin,

solid, metallic needles that penetrate

the skin. Research has shown that

low back pain is one area in which

acupuncture has benefited some

people.

More research is needed before the

effectiveness of these or other possible

alternative therapies can be definitively

stated. Health care providers may suggest

these therapies in addition to more

conventional treatments.

When Should Surgery Be

Considered and What Is Involved?

In many cases, the conditions causing spinal

stenosis cannot be permanently altered by

nonsurgical treatment, even though these

measures may relieve pain for a period of

time. To determine how much nonsurgical

treatment will help, a doctor may recommend

such treatment first. However, surgery might

be considered immediately if a patient has

numbness or weakness that interferes with

walking, impaired bowel or bladder function,

or other neurological involvement. The

effectiveness of nonsurgical treatments, the

extent of the patient's pain, and the patient's

preferences may all factor into whether or not

to have surgery.

The purpose of surgery is to relieve pressure

on the spinal cord or nerves and restore and

maintain alignment and strength of the spine.

This can be done by removing, trimming, or

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adjusting diseased parts that are causing the

pressure or loss of alignment. The most

common surgery is called decompressive

laminectomy: removal of the lamina (roof) of

one or more vertebrae to create more space

for the nerves. A surgeon may perform a

laminectomy with or without fusing vertebrae

or removing part of a disk. Various devices

may be used to enhance fusion and

strengthen unstable segments of the spine

following decompression surgery.

Patients with spinal stenosis caused by

spinal trauma or achondroplasia may need

surgery at a young age. When surgery is

required in patients with achondroplasia,

laminectomy (removal of the roof) without

fusion is usually sufficient.

What Are the Major Risks of

Surgery?

All surgery, particularly that involving general

anesthesia and older patients, carries risks.

The most common complications of surgery

for spinal stenosis are a tear in the

membrane covering the spinal cord at the site

of the operation, infection, or a blood clot that

forms in the veins. These conditions can be

treated but may prolong recovery. The

presence of other diseases and the physical

condition of the patient are also significant

factors to consider when making decisions

about surgery.

What Are the Long-Term Outcomes

of Surgical Treatment for Spinal

Stenosis?

Removal of the obstruction that has caused

the symptoms usually gives patients some

relief; most patients have less leg pain and

are able to walk better following surgery.

However, if nerves were badly damaged

before surgery, there may be some remaining

pain or numbness or no improvement. Also,

the degenerative process will likely continue,

and pain or limitation of activity may reappear

after surgery. NIAMS-supported researchers

have published results from the Spine Patient

Outcomes Research Trial (SPORT), the

largest trial to date comparing surgical and

non-surgical interventions for the treatment of

low back and associated leg pain caused by

spinal stenosis. The study found that for

patients with spinal stenosis, surgical

treatment was more effective than

Questions and Answers About Spinal Stenosis https://www.niams.nih.gov/health_info/spinal_stenosis/

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non-surgical treatment in relieving symptoms

and improving function. However, the

functional status of patients who received

non-surgical therapies also improved

somewhat during the study.

What Research Is Being Conducted

on Spinal Stenosis?

The National Institutes of Health (NIH) and

other federal agencies are supporting several

research projects related to spinal stenosis.

For example:

Continued followup of participants in

the SPORT trial will assess long-term

outcomes and the cost effectiveness

of surgical or nonsurgical

management of spinal stenosis and

other back problems.

SPORT researchers are also

developing web-based tools that

allow patients with low back disorders

to apply the best clinical evidence to

their individual circumstances and

make more informed treatment

choices about back surgery. A strong

collaboration of researchers will

develop, validate, and evaluate novel

methods for disseminating

individualized risk and benefit

information.

Researchers are investigating the

safety and value of new technologies

for the surgical treatment of back

problems.

Other studies are focused on

nonsurgical approaches for dealing

with back pain, including web-based

programs and complementary

therapies.

Researchers are working to identify

optimal approaches for the prevention

and early treatment of the many

underlying causes of spinal stenosis,

including osteoarthritis, rheumatoid

arthritis, and Paget’s disease.

More information on research is available

from the following websites:

National Institutes of Health (NIH)

Clinical Research Trials and You

was designed to help people learn

more about clinical trials, why they

matter, and how to participate. Visitors

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to the website will find information

about the basics of participating in a

clinical trial, first-hand stories from

clinical trial volunteers, explanations

from researchers, and links on how to

search for a trial or enroll in a

research-matching program.

ClinicalTrials.gov offers up-to-date

information for locating federally and

privately supported clinical trials for a

wide range of diseases and

conditions.

NIH RePORTER is an electronic tool

that allows users to search a

repository of both intramural and

extramural NIH-funded research

projects from the past 25 years and

access publications (since 1985) and

patents resulting from NIH funding.

PubMed is a free service of the U.S.

National Library of Medicine that lets

you search millions of journal citations

and abstracts in the fields of

medicine, nursing, dentistry,

veterinary medicine, the health care

system, and preclinical sciences.

What Can People Find More

Information About Spinal Stenosis?

National Institute of Arthritis and

Musculoskeletal and Skin Diseases

(NIAMS)

Information Clearinghouse

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-3675

Phone: 301-495-4484

Toll free: 877-22-NIAMS (877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

Email: NIAMSinfo@mail.nih.gov

Website: https://www.niams.nih.gov

If you need more information about available

resources in your language or another

language, please visit our website or contact

the NIAMS Information Clearinghouse at

NIAMSinfo@mail.nih.gov.

Other Resources

National Institute of Neurological

Disorders and Stroke

National Institutes of Health

Website: http://www.ninds.nih.gov

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American Academy of Orthopaedic

Surgeons

Website: http://www.aaos.org (con

información en español)

American College of Rheumatology

Website: http://www.rheumatology.org

North American Spine Society

Website: http://www.spine.org

Arthritis Foundation

Website: http://www.arthritis.org

Spondylitis Association of America

Website: http://www.spondylitis.org

Acknowledgments

The NIAMS gratefully acknowledges the

assistance of the following individuals in the

preparation and review of the original

version of this publication: David G.

Borenstein, M.D., Arthritis and Rheumatism

Associates, Washington, DC; James S.

Panagis, M.D., M.P.H., NIAMS/NIH; Peter C.

Gerszten, M.D., M.P.H, University of

Pittsburgh Medical Center, Pittsburgh, PA;

and James N. Weinstein, D.O., M.S.,

Dartmouth Medical School, Hanover, NH.

The mission of the National Institute of

Arthritis and Musculoskeletal and Skin

Diseases (NIAMS), a part of the U.S.

Department of Health and Human Services'

National Institutes of Health (NIH), is to

support research into the causes, treatment,

and prevention of arthritis and

musculoskeletal and skin diseases; the

training of basic and clinical scientists to

carry out this research; and the dissemination

of information on research progress in these

diseases. The NIAMS Information

Clearinghouse is a public service sponsored

by the NIAMS that provides health

information and information sources.

Additional information can be found on the

NIAMS website at www.niams.nih.gov.

For Your Information

This publication contains information about

medications used to treat the health condition

discussed here. When this publication was

developed, we included the most up-to-date

(accurate) information available.

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Occasionally, new information on medication

is released.

For updates and for any questions about any

medications you are taking, please contact

U.S. Food and Drug Administration

Toll free: 888-INFO-FDA

(888-463-6332)

Website: http://www.fda.gov

For additional information on specific

medications, visit Drugs@FDA at

http://www.accessdata.fda.gov/scripts

/cder/daf/. Drugs@FDA is a searchable

catalog of FDA-approved drug products.

For updates and questions about statistics,

please contact

Centers for Disease Control and

Prevention, National Center for

Health Statistics

Toll free: 800-232-4636

Website: http://www.cdc.gov/nchs

This publication is not copyrighted. Readers

are encouraged to duplicate and distribute as

many copies as needed.

Additional copies of this publication are

available from:

National Institute of Arthritis and

Musculoskeletal and Skin

Diseases (NIAMS)

Information Clearinghouse

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-3675

Phone: 301-495-4484

Toll free: 877-22-NIAMS

(877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

Email: NIAMSinfo@mail.nih.gov

Website: https://www.niams.nih.gov

NIH Publication No. 16–5327

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