What is lumbar spinal stenosis?

Lumbar spinal stenosis is the narrowing of the lumbar spinal canal, compressing the nerves that travel though the lower back to the legs. It can affect one or more lumbar levels, the most frequent being L4-L5, followed in descending order of frequency by L3-L4, L2-L3, L5-S1 and L1-L2.

Causes of lumbar spinal stenosis

Lumbar spinal stenosis can be either congenital or acquired. Below, we offer a description of both types in more detail:

1. Congenital lumbar spinal stenosis

Consists of a shortening of the pedicles that causes a narrowing of the anteroposterior diameter of the lumbar canal, as well as the exit point of the nerve roots.

2. Acquired lumbar spinal stenosis

Appears as a result of degenerative changes: 

  • Lumbar disc degeneration. 
  • Facet degeneration (synovitis, articular cartilage degeneration, synovial cyst formation…).
  • Formation of osteophytes. 
  • Hypertrophy of the yellow ligament. 

Symptoms of lumbar spinal stenosis

In patients with congenital lumbar spinal stenosis, symptoms that affect their quality of life may appear prematurely, between 30 and 50 years of age, while patients with acquired lumbar spinal stenosis usually develop symptoms after the age of 60.


The symptoms of lumbar spinal stenosis are listed here in order of frequency: 

  • Neurogenic claudication of the gait: this consists of pain, discomfort or heaviness in one or both legs, which appears when walking and forces the patient to stop and sit down to rest. After resting the patient can recover and continue walking. 
  • Tingling and numbness in one or both legs. 
  • Radiculopathy or damage in the nerves of one or both legs. 
  • Weakness or loss of strength in one or both legs. 
  • Low back pain
  • Urinary incontinence.

Diagnosis of lumbar spinal stenosis

To diagnose correctly whether a patient has lumbar spinal stenosis, image tests are needed in addition to the presence of symptoms typical of the disease:

Lumbar x-rays, AP, P and functional

Helps determine if there is any bone abnormality, the type of curvature and whether or not there is instability of the lumbar spine.

Lumbar MRI

Is the preferred test for the diagnosis of spinal stenosis, since it provides information about bone structures (not as defined as CT) and soft tissue such as the yellow ligament, intervertebral discs, the presence of synovial cysts…

Lumbar CT

Which gives a good resolution image of the bone structures.

Treatment of lumbar spinal stenosis


Treatment of lumbar spinal stenosis will depend on the severity of the patient's symptoms. If these are mild, it is possible to carry out a conservative treatment that includes one or more of the following measures.


  • Pain relievers (ibuprofen, naproxen, paracetamol ...).
  • Neuroleptic medications (gabapentin, pregabalin ...) used to relieve pain caused by nerve injuries.
  • Tricyclic antidepressants (amitriptyline) can relieve chronic pain.
  • Opioids (oxycodone, hydrocodone ...) can be considered to treat acute episodes of pain as short-term treatment or for prolonged treatment that would be difficult to manage with other drugs. 


When patients become less active because of pain, this causes muscle weakness, which in turn, may cause the patient’s pain to increase. Exercises designed to increase the strength and endurance of the vertebral musculature and maintain the flexibility and stability of the spine can have beneficial effects in patients with lumbar spinal stenosis.


Injection of steroids into the space around the nerve can help reduce inflammation and relieve pain.


Surgery is the treatment of choice when other therapies have not been effective or when symptoms are severe. The objective of the surgery is to decompress the area of stenosis and thus release the compressed roots. 

There are various types of surgery for this pathology:

Lumbar laminectomy

This is the standard treatment for lumbar spinal stenosis not associated with spondylolisthesis or degenerative scoliosis. It consists of the extraction of the lamina (posterior part of the vertebra), hypertrophic yellow ligament and osteophytic areas of the facets that are contributing to the narrowing of the spinal canal, in order to free the dural sac and nerve roots.


This is indicated in the cases of patients with unilateral stenosis and unilateral symptoms. In this procedure, the surgeon resects only the lamina on the affected side and the integrity of the interspinous and supraspinatus ligaments is preserved, thus minimizing spinal instability.

Unilateral or bilateral laminotomy

This consists of a focal decompression, removing only a portion of the vertebral lamina to release the compressed nerve roots.

Expansive laminoplasty

This  technique consists of widening the lumbar canal by elevating the laminae involved in the stenosis and subsequently placing an autologous bone graft on the surface of the operated levels, in order to maintain the stability of the spine. 

Lumbar instrumentation

May be necessary in cases of lumbar stenosis associated with spondylolisthesis (displacement of one vertebra with respect to another), in which laminectomy can increase spinal instability. 

Who are the doctors at Instituto Clavel who treat lumbar spinal stenosis?


  • Effectiveness of surgery versus conservative treatment for lumbar spinal stenosis: A system review and meta-analysis of randomized controlled trials. Ma XL, Zhao XW, Ma JX, Li F, Wang Y, Lu B. Int J Surg. 2017 Aug;44:329-338. doi: 10.1016/j.ijsu.2017.07.032. Epub 2017 Jul 10. Review.
  • Lumbar spinal stenosis. From diagnosis to correct therapy. Benditz A, Grifka J, Matussek J. Z Rheumatol. 2015 Apr; 74(3):215-24; quiz 225.
  • Lumbar spinal stenosis: syndrome, diagnostics and treatment. Siebert E, Prüss H, Klingebiel R, Failli V, Einhäupl KM, Schwab JM. Nat Rev Neurol. 2009 Jul; 5(7):392-403.
  • Non-operative treatment of lumbar spinal stenosis. Beyer F, Geier F, Bredow J, Oppermann J, Schmidt A, Eysel P, Sobottke R. Technol Health Care. 2016 Jul 27;24(4):551-7
  • Surgical versus non-surgical treatment for lumbar spinal stenosis. Zaina F et al. Cochrane Database Syst Rev. (2016)
  • Management of lumbar spinal stenosis. Lurie J et al. BMJ. (2016)

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