Spinal Stenosis: Understanding Symptoms, Causes & Treatment

What Is Spinal Stenosis?

Spinal stenosis is a narrowing of the spinal canal, the bony channel that houses and protects the spinal cord and nerve roots. As this channel becomes smaller, the neural structures within it can become compressed, leading to the characteristic symptoms of the condition. Spinal stenosis most commonly affects the lumbar (lower back) and cervical (neck) regions of the spine, though it can occur at any level.

The condition may be congenital, meaning some individuals are born with a naturally narrow spinal canal, but in most cases it is acquired, developing gradually over years as a result of age-related degenerative changes in the spine. Importantly, narrowing visible on imaging does not always produce symptoms. A diagnosis of spinal stenosis is made only when structural narrowing corresponds with clinical symptoms.

Types of Spinal Stenosis

Spinal stenosis is classified by both its location and the specific area of the canal that is affected:

• Central canal stenosis: Narrowing of the main spinal canal itself. In the lumbar spine, this compresses the bundle of nerve roots known as the cauda equina. In the cervical spine, it can compress the spinal cord directly, which carries more serious implications.
• Foraminal stenosis (lateral stenosis): Narrowing of the neural foramina, the small openings on either side of each vertebra through which individual nerve roots exit the spinal canal. This is a common cause of radicular symptoms such as leg or arm pain.
• Lumbar spinal stenosis: The most common form, affecting the lower back. 
• Cervical spinal stenosis: Affects the neck and can lead to myelopathy, a condition involving spinal cord compression that may cause balance difficulties, hand clumsiness and gait disturbances. Cervical stenosis requires close monitoring because spinal cord damage can be difficult to reverse.

What Causes Spinal Stenosis?

The primary driver of spinal stenosis is age-related degeneration of the spinal structures. Over time, several changes can contribute to narrowing of the spinal canal:

• Degenerative disc disease: As discs lose hydration and height, the space available for nerves decreases and the overall mechanics of the spine change. This is the most common underlying contributor. Learn more about degenerative disc disease.
• Osteoarthritis and facet joint hypertrophy: The facet joints that connect vertebrae can enlarge as cartilage wears away and the body forms new bone in response to instability.
• Bone spurs (osteophytes): Bony overgrowths that develop along the edges of vertebrae or facet joints can protrude into the spinal canal or foramina.
• Ligament thickening: The ligamentum flavum, which runs along the back of the spinal canal, can thicken and buckle inward with age, further reducing available space.
• Herniated discs: A disc that bulges or herniates can directly narrow the canal or foramina. Learn more about herniated disc causes and treatment.
• Spondylolisthesis: When one vertebra slips forward over the one below it, it can narrow the canal and compress nerves at that level.

Less common causes include spinal tumors, trauma and prior spinal surgery that has altered the anatomy of the canal.

Spinal Stenosis Symptoms

Symptoms of spinal stenosis depend on which region of the spine is affected, and which neural structures are compressed. Some patients have significant narrowing on imaging but experience minimal symptoms, while others may have moderate narrowing with considerable functional limitation.

Lumbar Spinal Stenosis Symptoms

• Neurogenic claudication: This is the hallmark symptom, a heavy, cramping or aching pain in the buttocks, thighs or calves that worsens with walking or prolonged standing and improves with sitting or bending forward. Many patients notice they can walk farther when leaning on a shopping cart or walking uphill because the forward-flexed position opens the spinal canal.
• Low back pain, often described as a deep ache
• Numbness or tingling in the legs or feet
• Leg weakness, which may cause a feeling of instability or difficulty climbing stairs
• In severe cases: bowel or bladder dysfunction. This is a medical emergency requiring immediate evaluation.

Lumbar stenosis is also a common underlying cause of sciatica, radiating pain that travels from the lower back down one leg.

Cervical Spinal Stenosis Symptoms

• Neck pain that may radiate into the shoulders or arms
• Numbness, tingling or weakness in the hands and arms
• Loss of fine motor skills, such as difficulty with buttons or handwriting
• Balance and coordination problems, unsteady gait

How Is Spinal Stenosis Diagnosed?

Diagnosis begins with a thorough medical history and a physical and neurological examination. Your provider will evaluate your posture, gait, reflexes, muscle strength and sensation. They will also assess which positions or activities reproduce your symptoms. For example, whether your leg pain worsens with standing and improves with sitting is characteristic of lumbar stenosis.

Imaging studies are essential for confirming the diagnosis and identifying the precise location and severity of the narrowing. An MRI is the gold standard, providing detailed visualization of the discs, ligaments, nerves and spinal cord. X-rays are used to evaluate bone alignment, disc height and the presence of bone spurs or spondylolisthesis. In some cases, a CT scan or CT myelogram may be ordered for more detailed bone imaging, and electrodiagnostic testing (EMG and nerve conduction studies) can help evaluate nerve function when the clinical picture is unclear.

Spinal Stenosis Treatment

Non-Surgical Treatment

Non-surgical treatment is the appropriate first step for most patients with spinal stenosis. While conservative measures do not reverse the structural narrowing, they can meaningfully reduce symptoms and improve function. Our treatment approach typically includes:

• Activity modification: avoiding prolonged standing and walking, using flexion-based positioning (such as leaning forward slightly) when symptoms flare
• Physical therapy: a structured program focused on core and lumbar stabilization, flexibility, posture training and aerobic conditioning; aquatic therapy can be particularly effective because the buoyancy of water reduces spinal loading
• Anti-inflammatory medications (NSAIDs) for pain and inflammation management
• Epidural steroid injections: these can provide short-to-medium-term relief by delivering anti-inflammatory medication directly to the area of nerve compression; they are particularly helpful for managing flare-ups and facilitating participation in physical therapy
• Assistive devices such as a cane or rollator walker, if needed for safety and mobility

Surgical Treatment

Surgery is considered when symptoms significantly limit daily function despite an adequate trial of conservative treatment, or when there is evidence of progressive neurological decline such as worsening weakness, balance impairment or bowel/bladder changes. The goal of surgery is to decompress the neural structures by creating more space within the spinal canal. Common procedures include:

• Laminectomy: Removal of the lamina (the back part of the vertebra that forms the roof of the spinal canal) to relieve pressure. This is the most frequently performed surgery for lumbar stenosis.
• Laminotomy: A less extensive procedure that removes only a portion of the lamina, preserving more of the spinal structure.
• Foraminotomy: Enlargement of the neural foramen to relieve compression on a specific nerve root as it exits the spine.
• Minimally invasive decompression: These techniques achieve the same decompression goals through smaller incisions with less muscle disruption, often resulting in shorter hospital stays and faster recovery. Learn more about minimally invasive spine surgery at Panorama.
• Spinal fusion: When stenosis is accompanied by instability or spondylolisthesis, a fusion may be performed in conjunction with decompression to stabilize the affected segment. Your surgeon will discuss whether fusion is necessary based on your imaging and clinical presentation.

Recovery and Long-Term Outlook

For patients who respond well to conservative care, ongoing management typically involves a regular exercise program, periodic check-ins with their provider and activity modification during flare-ups. Research suggests that approximately one-third of patients with lumbar stenosis improve with conservative treatment, roughly half remain stable and a smaller percentage experience worsening symptoms over time.

For patients who undergo surgical decompression, outcomes are generally favorable. Most patients experience significant improvement in leg pain, walking tolerance and overall function. Physical therapy after surgery is an important part of recovery. Studies show that patients who begin rehabilitation within the first six weeks after surgery tend to have better outcomes at one year. Recovery timelines vary by procedure, but many patients return to light activities within a few weeks and resume full activity within three to six months.

When to See a Spine Specialist

You should consider seeing a spine specialist if you are experiencing:

• Leg pain, heaviness or cramping that limits your ability to walk more than a short distance
• Progressive weakness or numbness in your legs or arms
• Balance problems or frequent stumbling
• Neck pain accompanied by hand weakness or coordination changes
• Any changes in bowel or bladder function. Seek emergency care immediately.

Why Choose Panorama Orthopedics & Spine Center

At Panorama Orthopedics & Spine Center, our team of spine specialists includes orthopedic spine surgeons, a neurosurgeon, physiatrists (interventional pain physicians) and spine-specialized physical therapists. As one of the largest independent orthopedic practices in Colorado with more than 35 physicians across 4 Denver metro locations, we provide comprehensive spinal stenosis treatment from diagnosis through recovery.

Our spine surgeons perform procedures at facilities across the region, including OrthoColorado Hospital, the only orthopedic specialty hospital in the Rocky Mountain region. Panorama has been named one of the top three orthopedic practices in Colorado by Castle Connolly (2026), and a record-breaking 21 of our physicians were named to the 5280 Top Doctors list (2025).

We offer same-day and next-day appointments, complimentary spine MRI reviews and convenient locations across the Denver metro area. Whether you are exploring non-surgical options or considering surgery for spinal stenosis, our multidisciplinary team is here to help you find the right path forward. Schedule an appointment today to start your evaluation.