New Standards for the Diagnosis of Lumbar Spinal Canal Stenosis

It’s one of the more com­mon spinal prob­lems for peo­ple over 55 – lum­bar spinal steno­sis.

Smaller Than Average Spinal Canal Predisposes to Symptomatic Stenosis

Small­er Than Aver­age Spinal Canal Pre­dis­pos­es to Symp­to­matic Steno­sis

You get low back pain and leg pain that’s worse stand­ing or walk­ing.  You feel bet­ter bend­ing for­ward or sit­ting down.  And your legs tire pre­ma­ture­ly when you walk.

The symp­toms of spinal steno­sis are com­mon­ly caused by nar­row­ing of the spinal canal from grad­ual spinal joint degen­er­a­tion.  The nerves of the spinal cord get pinched, caus­ing pain and leav­ing your leg mus­cles weak­ened.

Although spinal steno­sis is com­mon, the stan­dards for diag­nos­ing it are con­tro­ver­sial.  Some doc­tors focus on the nature of the pain and the way it behaves.  Oth­ers focus on imag­ing stud­ies such as MRIs that pic­ture the amount of space avail­able for the spinal cord.

The prob­lem is that not every­one with steno­sis-like symp­toms has canal nar­row­ing that shows up on MRI.  And vice ver­sa – not every­one with spinal canal nar­row­ing has pain, weak­ness, or oth­er symp­toms.

This is the conun­drum that the authors of a recent arti­cle in the jour­nal Spine tried to clar­i­fy.  They want­ed to see what the best diag­nos­tic tests for spinal steno­sis were.

Here’s what they found:  MRIs are often the most accu­rate imag­ing test to show the nar­row­ing of the spinal canal.  But they shouldn’t be used in iso­la­tion.  MRIs are most mean­ing­ful when they’re cor­re­lat­ed with spe­cif­ic phys­i­cal signs.  The most sig­nif­i­cant phys­i­cal find­ings include

  • Radi­at­ing leg pain that is exac­er­bat­ed while stand­ing up
  • The absence of pain when seat­ed
  • The improve­ment of symp­toms when bend­ing for­ward, and
  • A wide-based gait


Deepen Your Body of Knowledge

What caus­es spinal steno­sis and what you can do about it

Low­er back pain when stand­ing

Spondy­lolis­the­sis — anoth­er cause of steno­sis


About Ronald Lavine, D.C.

Dr. Lavine has more than thirty years' experience helping patients alleviate pain and restore health using diverse, scientifically-based manual therapy and therapeutic exercise and alignment methods.

His website,, provides more information about his approach.

Please contact him at or at 212-400-9663.

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