Back and neck
Spinal stenosis
Spinal stenosis is narrowing of the spinal canal or of the openings through which nerve roots leave it, reducing the space available to the neural structures. It is usually a consequence of age-related change — thickened ligament, enlarged facet joints and bulging discs together encroaching on the canal. In the low back it characteristically produces leg symptoms that appear with walking or standing and ease on sitting or bending forward; in the neck it can affect the spinal cord itself, which is a different and more urgent picture.
Symptoms
The relationship between the symptoms and posture is the most characteristic feature, and the most useful diagnostically.
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Neurogenic claudication
Aching, heaviness or numbness in the legs that builds with walking or standing and settles within minutes of sitting or leaning forward. Many people find walking uphill or pushing a trolley easier, because both involve flexion.
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Symptoms in both legs
More often bilateral than radiculopathy from a single disc, though it can be one-sided where one root opening is narrowed.
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Reduced walking distance
A gradually shortening distance before symptoms appear is a common account, and is worth quantifying because it is the most practical measure of severity.
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Cervical stenosis
In the neck, cord involvement may produce clumsiness of the hands, changes in handwriting, unsteadiness when walking or symptoms in all four limbs. This is assessed promptly.
Diagnosis
The main task is to distinguish it from other causes of leg pain on walking, which are treated entirely differently.
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History and examination
The posture-dependence of the symptoms, walking distance, and a neurological examination of the legs including reflexes, power and sensation.
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MRI
The usual imaging test, showing the degree of narrowing and which levels are involved. As always, the appearance is correlated with the symptoms rather than read alone.
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Distinguishing vascular claudication
Leg pain from arterial disease also comes on with walking, but eases on standing still rather than requiring flexion, and is accompanied by different examination findings. Vascular assessment is used where the picture is unclear.
Common questions
Why can I cycle further than I can walk?
Cycling is performed in a flexed position, which opens the canal and relieves pressure on the neural structures. The same mechanism explains why leaning on a trolley helps.
Does stenosis always get worse?
It tends to progress slowly, but the course varies considerably and many people remain stable for long periods. Rapid deterioration is not typical and warrants reassessment.
Is surgery the only thing that works?
No. Many people manage well with exercise, activity modification and periodic injections. Surgery is generally considered when walking limitation becomes the dominant problem.
Is it the same as a herniated disc?
They are different, although they can coexist. A herniation is focal displacement of disc material, usually affecting one root; stenosis is generalised narrowing that more often affects several.
General reference information, and not advice about your own case. It may not reflect the most recent guidance or what is offered on a given day — call (201) 408-5151 to check.
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