What are the clinical features of spinal stenosis (narrowing of the spinal canal)?

From the Guidelines

Spinal stenosis typically presents with neurogenic claudication, characterized by pain, numbness, and weakness in the legs that worsens with walking or standing and improves with sitting or leaning forward. This condition is often associated with degenerative changes in the spine, and symptoms can develop gradually over time 1. Patients with spinal stenosis may describe a heavy, tired feeling in their legs and may need to sit down after walking short distances.

Key Clinical Features

• Lower back pain is common but may not be the predominant complaint
• Diminished reflexes, sensory deficits in a dermatomal pattern, and occasionally motor weakness may be present on physical examination
• Patients with cervical stenosis may experience neck pain, arm pain, numbness in the hands, and problems with fine motor coordination
• Lumbar stenosis patients often adopt a stooped posture when walking to relieve symptoms by increasing the spinal canal diameter
• The pain distribution depends on the level of stenosis, with lumbar stenosis affecting the lower extremities and cervical stenosis affecting the upper extremities
• Symptoms are often positional, with extension worsening pain and flexion providing relief, which helps distinguish spinal stenosis from vascular claudication 1.

Important Considerations

• Cauda equina syndrome, characterized by bowel or bladder dysfunction, saddle anesthesia, and bilateral leg weakness, is a rare but serious complication requiring immediate medical attention
• Magnetic resonance imaging (MRI) or CT is recommended for evaluating patients with persistent back and leg pain who are potential candidates for invasive interventions, as plain radiography cannot visualize discs or accurately evaluate the degree of spinal stenosis 1.

From the Research

Clinical Features of Spinal Stenosis

• Spinal stenosis is characterized by the narrowing of the spinal canal, causing compression of the spinal cord, which can lead to pain and numbness in the low back, legs, and buttocks after walking or extension of the lumbar spine 2.
• The symptoms associated with lumbar spinal stenosis are usually relieved with flexion of the lower back 2.
• Lumbar spinal stenosis may be classified by etiology (e.g., congenital or acquired) or by symptom complex (radiculopathy, neurogenic claudication, or mechanical back pain) 3.
• The clinical syndrome of lumbar spinal stenosis is characterized by lower extremity pain caused by mechanical compression on the neural elements or their blood supply 3.
• Symptoms of spinal stenosis can include weakness, reflex alterations, gait disturbances, bowel or bladder dysfunction, motor and sensory changes, radicular pain, or atypical leg pain and neurogenic claudication 4.
• The diagnosis of lumbar spinal stenosis can be made based on a clinical history of back and lower extremity pain that is provoked by lumbar extension, relieved by lumbar flexion, and confirmed with cross-sectional imaging 5.

Common Symptoms

• Back and leg pain 2, 5
• Numbness in the low back, legs, and buttocks 2
• Neurogenic claudication 3, 4
• Radiculopathy 3
• Mechanical back pain 3
• Weakness 4
• Reflex alterations 4
• Gait disturbances 4
• Bowel or bladder dysfunction 4
• Motor and sensory changes 4
• Radicular pain 4
• Atypical leg pain 4

Diagnostic Criteria

• Clinical history of back and lower extremity pain 5
• Pain provoked by lumbar extension 5
• Pain relieved by lumbar flexion 5
• Confirmation with cross-sectional imaging (e.g., computed tomography or magnetic resonance imaging) 5