Spinal stenosis happens when the space inside the backbone is too small. This can put pressure on the spinal cord and nerves that travel through the spine. Spinal stenosis happens most often in the lower back and the neck.

Some people with spinal stenosis have no symptoms. Others may experience pain, tingling, numbness and muscle weakness. Symptoms can get worse over time.

The most common cause of spinal stenosis is wear-and-tear damage in the spine related to arthritis. People who have serious spinal stenosis may need surgery.

Surgery can create more space inside the spine. This can ease the symptoms caused by pressure on the spinal cord or nerves. But surgery can't cure arthritis, so arthritis pain in the spine may continue.

Spinal stenosis often causes no symptoms. When symptoms do happen, they start slowly and get worse over time. Symptoms depend on which part of the spine is affected.

In the lower back

Spinal stenosis in the lower back can cause pain or cramping in one or both legs. This happens when you stand for a long time or when you walk. Symptoms get better when you bend forward or sit. Some people also have back pain.

In the neck

Spinal stenosis in the neck can cause:

• Numbness.
• Tingling or weakness in a hand, leg, foot or arm.
• Problems with walking and balance.
• Neck pain.
• Problems with the bowel or bladder.

Spinal bones are stacked in a column from the skull to the tailbone. They protect the spinal cord, which runs through an opening called the spinal canal.

Some people are born with a small spinal canal. But most spinal stenosis occurs when something happens to reduce the amount of open space within the spine. Causes of spinal stenosis include:

• Bone spurs. Wear-and-tear damage from arthritis can cause extra bone to grow on the spine. This creates bone spurs that can push into the spinal canal. Paget's disease also can cause extra bone to grow on the spine.
• Herniated disks. Disks are the soft cushions that act as shock absorbers between the spinal bones. If part of the disk's soft inner material leaks out, it can press on the spinal cord or nerves.
• Thick ligaments. The strong cords that help hold the bones of the spine together can become stiff and thick over time. Thick ligaments can push into the spinal canal.
• Tumors. Rarely, tumors can form inside the spinal canal.
• Spinal injuries. Car accidents and other trauma can cause spinal bones to break or move out of place. Swelling of nearby tissue right after back surgery also can put pressure on the spinal cord or nerves.

Most people with spinal stenosis are over age 50. Younger people may be at higher risk of spinal stenosis if they have scoliosis or other spinal problems.

Your healthcare professional may ask about your symptoms and medical history. You may have a physical exam. You also may need an imaging test to help find the problem.

Imaging tests

These tests may include:

• X-rays. An X-ray of the back can show bone changes that may be making the space within the spinal canal smaller. Each X-ray involves a small dose of radiation.
• Magnetic resonance imaging (MRI). An MRI uses a powerful magnet and radio waves to produce detailed images of hard and soft tissue. The test can detect damage to the disks and ligaments. 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, a contrast dye is injected to outline the spinal cord and nerves. This can show herniated disks, bone spurs and tumors.

Your healthcare professional may suggest:

• Pain relievers. Medicines you can buy without a prescription — such as aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) and acetaminophen (Tylenol, others) — can help reduce pain and swelling.
• Weight loss. Losing excess weight can reduce pain by taking some stress off the lower back.
• Exercise. Stretching and strengthening exercises may help relieve symptoms. Talk with your healthcare team about what exercises are safe to do at home.
• Walking aids. In addition to providing stability, canes and walkers can help relieve pain by allowing you to bend forward while walking.

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

• Massage therapy.
• Chiropractic treatment.
• Acupuncture.

You might be referred to a doctor who specializes in disorders of the nervous system, called a neurologist. Depending on how serious your symptoms are, you also may need to see a spinal surgeon, which could be a neurosurgeon or an orthopedic surgeon.

What you can do

Before the appointment, you might want to prepare a list of answers to the following questions:

• When did you first notice this problem?
• Has it worsened with time?
• Have your parents or siblings ever had similar symptoms?
• Do you have other medical problems?
• What medicines or supplements do you take regularly?
• What spine surgeries or injections have you had?

What to expect from your doctor

Your healthcare professional may ask some of the following questions:

• Do you have pain? Where is it?
• Does any position ease the pain or worsen it?
• Do you have any weakness, numbness or tingling?
• Do you feel clumsier lately?
• Have you had any difficulty controlling your bowel or bladder?
• What treatments have you tried already for these problems?