Spinal stenosis symptoms and diagnosis

Symptoms of spinal stenosis
Generally speaking the various types of stenosis produce similar symptoms. Pain with limitations on walking is the most common symptom of lumbar spinal stenosis.

Pain in the legs with walking (claudication) can be caused by either vascular insufficiency (vascular claudication) or from spinal stenosis (neurogenic or pseudoclaudication). Pain with either condition will go away with rest, but with spinal stenosis the patient usually has to sit down to ease the leg pain. Vascular claudication will go away if the patient simply stops walking.

Although occasionally the symptoms and leg pain from spinal stenosis will come on acutely, they generally develop over several years. The longer a patient with spinal stenosis stands or walks the worse the leg pain will get. Flexing forward or sitting will open up the spinal canal and relieve the leg pain and other symptoms, but they recur if the patient gets back into an upright posture. Numbness and tingling can accompany the pain, but weakness is a rare symptom of spinal stenosis.

Overall, the symptoms of spinal stenosis are often characterized as follows:

• Develop slowly over time

• May come and go, as opposed to continuous pain

• Occurs during certain activities and/or positions

• Relieved by rest and/or any flexed forward position

Diagnosis of spinal stenosis
Diagnostic imaging studies for spinal stenosis patients include either a MRI scan or a CT scan with myelogram, and sometimes both. Unenhanced CT scans are of limited value.

It can be shown that each form of spinal stenosis has a dynamic (changing) effect on nerve compression, such as when bearing weight. Due to this changing compression, the symptoms of spinal stenosis vary from time to time and the physical examination generally will not show any neurological deficits or motor weakness.

Foraminal stenosis can be pinpointed not only by the CT and MRI scans, but also by injecting the suspicious nerve with a local anesthetic (selective nerve root block). After the injection a remission of spinal stenosis symptoms on walking, along with true temporary weakness of the limb, is clinically diagnostic and helps the patient to decide about surgery.

Since a spinal stenosis at two or even three levels (sub-laminar, foraminal and far lateral) can affect a single emerging nerve, a combination of anatomical and clinical clarification is needed in order to make sure that one surgical procedure will address all contributing components of spinal stenosis.