Lumbar spinal stenosis is a condition resulting from progressive narrowing of the spinal canal. The consequence of stenosis is degeneration of the small joints and discs of the spine. Due to excessive pressure on the discs, osteophytes, called osteophytes, develop and grow into the spinal canal, leading to stenosis. The narrowing of the space in the area that houses the nerve roots causes arthritis in the small joints of the spine, causing swelling of the spinal joints. The spinal ligaments, especially the ligamentum flavum, become stiff and less flexible and thicken with age, which can also cause spinal stenosis. These processes that lead to spinal stenosis may cause compression of the nerve roots and spinal cord, which can produce symptoms of spinal stenosis. Stenosis can also occur in the center of the spinal canal (central stenosis), which is where the spinal cord or cauda equina is located, as well as in the passage of nerve roots through the central spinal canal (lateral saphenous stenosis), or in the lateral foramina (foraminal stenosis), which is the foramen where a single nerve root penetrates the body. Virtually everyone has varying degrees of deformation of the spinal canal as they age, but the severity of symptoms depends on the degree of narrowing of the spinal canal and the degree of nerve damage. The degree of degeneration varies greatly from person to person, but not everyone has symptoms. Spinal stenosis is a reduction in the space of the spinal canal that houses the nerve tissue. Degenerative disease is the most common cause, but there are other specific causes, including calcium and phosphate crystalline deposits, amyloid deposits and intradural spinal cord tumors. The causes of spinal stenosis leading to weakness and pain have been a matter of research and debate in the medical community. The most common symptoms of hip and leg pain in lumbar stenosis may be related to compression of the microvasculature that carries blood to the nerve roots. At the same time nerve root compression is a direct cause of lumbar spinal stenosis symptoms. All of the above abnormalities have the potential to affect the normal function of the nerve roots and reduce the effectiveness and durability of the spinal nerves. 1. Symptoms Some patients with degenerative lumbosacral spine disease are asymptomatic, some have moderate discomfort in the low back, and some are unable to walk normally at all. The typical patient with spinal stenosis will initially have pain in the buttocks, thighs and calves from standing and walking, and then will feel pain in those areas at rest as well. Sometimes the patient may experience pain and weakness in the legs without any back pain. More severe symptoms include numbness, abnormal sensation and weakness at the ends of the limbs. There are specific positions that can relieve the symptoms caused by spinal stenosis. These positions are lumbar dorsiflexion and forward bending. “Any position that allows the lumbar spine to be bent over can provide relief. “As an example, patients with spinal stenosis don’t feel pain at all when riding a bicycle or walking up stairs. They can go farther if they have something to lean on, such as a shopping cart at the mall. But when they go down the stairs or lose the support of the shopping cart, the symptoms reappear. The appearance and severity of spinal stenosis symptoms depend on the following: the original width of the spinal canal, the sensitivity of the involved nerves, the different requirements of the patient’s work environment for spinal function, and the pain tolerance of different patients. 2. Diagnosis The diagnosis of spinal stenosis begins with a complete medical history and detailed physical examination. The physician determines the type of symptoms, the cause of exacerbation or relief of symptoms, and the duration of symptoms. The physical examination is important to determine the severity of the condition and whether there is weakness or numbness in specific areas. Neurologic examination can reveal abnormalities in strength and sensation in specific areas, and these signs provide the most objective basis for the diagnosis of chronic nerve root compression due to spinal stenosis. Laboratory tests alone cannot confirm the presence of spinal stenosis, but they help in the diagnosis of the specific etiology of nerve root and spinal cord malfunction. Routine lumbar spine radiology helps to determine the degree of spinal degeneration, thus providing a direct basis for the diagnosis of spinal stenosis. X-rays can determine the exact location of spinal instability from which spinal stenosis symptoms may be caused. CT shows the bone structure of the spine very clearly and is an indispensable tool for determining the location of spinal stenosis. EMG (electromyography) can identify the abnormal nerve roots from among multiple involved nerve roots.