What it is
Stenosis is narrowing of the space available to the nerves in the lower back. It develops slowly, from thickened ligament, enlarged facet joints and bulging discs — the ordinary changes of age, in a canal that may have been on the narrow side to begin with.
Symptoms
- Pain, heaviness or cramping in both legs that builds with walking or standing
- Relief within a minute or two of sitting down or leaning forward
- A shrinking walking distance measured in blocks
- Numbness or weakness in the legs; balance that feels less reliable
Back pain is often present but is rarely the dominant complaint.
How it is diagnosed
The history is characteristic enough that the diagnosis is often clear before imaging: symptoms brought on by walking, relieved by flexion. MRI confirms the level and severity. Standing X-rays are important because they show instability or slippage that a lying-down MRI does not.
Non-surgical treatment
Physical therapy aimed at flexion-based conditioning, activity modification, walking aids where appropriate, anti-inflammatory medication and epidural steroid injections. Many people manage well for years without an operation.
When surgery is considered
When walking distance has fallen to the point it limits the life you want, or when there is progressive weakness. Decompression — making room for the nerves — is a reliable operation for the leg symptoms. A fusion is added only where there is instability or deformity, not routinely, and Dr. Long will explain exactly why if he recommends one.