Spinal stenosis: what it means on your MRI

What is spinal stenosis?

Spinal stenosis means the spaces inside your spine have gotten narrower. These are the spaces your nerves travel through.

"Stenosis" just means narrowing. Your report may say where it is:

• Central canal stenosis: the main tunnel in the middle of the spine.
• Lateral recess or subarticular stenosis: the side gutters where nerves start to branch off.
• Foraminal stenosis: the openings where nerves exit to your arms or legs (see foraminal narrowing)

What causes spinal stenosis?

Most often, gradual age-related changes that add up and crowd the space:

• Thickening of a ligament at the back of the canal (ligamentum flavum).
• Arthritis and enlargement of the facet joints.
• Disc bulges.
• One vertebra slipping forward on another (spondylolisthesis).

Some people are born with a narrower canal. Doctors call this congenital stenosis. For them, smaller changes cause crowding sooner.

What does lumbar (low back) stenosis feel like?

The classic symptom is leg pain, heaviness, numbness, or tingling. It comes on with standing or walking. It eases when you sit or bend forward.

Many people notice they can walk further leaning on a shopping cart. Doctors call this pattern neurogenic claudication. Leg pain from poor circulation can look similar. But that kind of pain usually eases just by stopping, even while standing.

What does cervical (neck) stenosis feel like?

Neck stenosis can press on the spinal cord itself. This causes a different set of symptoms. Doctors call it myelopathy.

Watch for:

• Clumsy hands, trouble with buttons or handwriting
• Dropping things
• Trouble with balance or walking
• Legs that feel stiff or heavy

See a spine specialist promptly if your report mentions cord compression, cord signal change, or myelomalacia. Do this even if your pain is mild.

What do "mild," "moderate," and "severe" stenosis mean?

They describe how much space is left compared with normal.

Some reports also give measurements in millimeters. The grade helps your clinician, but it doesn't decide treatment on its own. People with severe stenosis on MRI can have few symptoms. The reverse happens too.

Does spinal stenosis get worse over time?

Low back stenosis often stays about the same for years. Many people's symptoms stay stable or improve.

Neck stenosis that is pressing on the spinal cord is different. It is more likely to progress. That is why it gets closer follow-up.

How is spinal stenosis treated?

Most people with low back stenosis start with non-surgical care:

• Physical therapy, often with forward-bending exercises.
• Building walking tolerance a little at a time.
• Pain or anti-inflammatory medicine, if your clinician recommends it.
• Epidural steroid injections for symptoms that limit daily life.

Surgery to make more room is called decompression or laminectomy. It may be an option when symptoms keep limiting your walking or daily life. Some people also need a fusion if the spine is unstable. For neck stenosis with cord symptoms, surgery is discussed earlier.