Spinal Stenosis

Spinal stenosis is a narrowing of the spinal canal that compresses the nerves running through it — evaluated and treated by board-certified pain management physicians at Remix Medical in Houston.

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By Raju Mantena, DO · Pain Medicine PhysicianReviewed Jul 31, 20262 min read

Key takeaways

Spinal stenosis is a narrowing of the spinal canal that compresses the cord and nerve roots, most often acquired gradually with age from arthritis and bone spurs, bulging discs, thickened ligamentum flavum, or spondylolisthesis.
Lumbar stenosis classically causes neurogenic claudication — leg pain or heaviness with standing and walking that eases on sitting or leaning forward — while cervical stenosis more often causes hand numbness, clumsiness, and gait changes.
Imaging alone isn't the diagnosis: many people have radiographic stenosis without symptoms, so MRI or CT findings must be correlated with the patient's actual symptoms and the specific level treated.
Most patients improve without surgery, and the natural history of mild-to-moderate disease is favorable in a third to half of patients. First-line care is multimodal — education, flexion-based physical therapy, and conditioning — with fluoroscopically guided epidural steroid injections for short-to-medium-term relief.
Surgery is reserved for disabling symptoms, severe claudication, or progressive weakness and is almost always elective — while sudden bladder or bowel changes, saddle numbness, or rapidly worsening weakness signal cauda equina syndrome, an emergency.

Spinal stenosis rarely announces itself. It arrives as a shorter walk to the mailbox, a longer rest on a grocery store bench, a lean over the shopping cart that somehow makes the legs work again. At Remix Medical in Houston, our board-certified pain management physicians treat spinal stenosis with image-guided, non-surgical care aimed at the specific level of the spine causing your symptoms.

What is Spinal Stenosis?

Spinal stenosis is a narrowing of the space inside the spinal canal. As that space closes, pressure builds on the spinal cord and the nerve roots traveling through it, producing pain, numbness, tingling, and weakness in the limbs.

Some people carry a naturally narrow canal and never develop symptoms. Most cases are acquired, developing gradually as the structures surrounding the canal thicken, bulge, or shift inward with age.

Common Causes of Spinal Stenosis

1. Osteoarthritis and Bone Spurs

Arthritic change in the facet joints prompts the body to lay down new bone. These spurs encroach on the canal and reduce the room available to the nerves.

2. Herniated or Bulging Discs

As discs dry and lose height, their outer wall can tear or bulge backward into the canal, adding pressure and inflammation at that level.

3. Thickened Ligaments

The ligamentum flavum stiffens and thickens with age. It buckles inward, crowding the canal from behind.

4. Spondylolisthesis

One vertebra slips forward on the one below it, misaligning the canal and pinching the nerves at that segment.

5. Trauma

Fractures and dislocations can narrow the canal directly, or through the swelling and scar tissue that follow.

How Remix Medical Can Help

Diagnosis starts with a physical exam and history, supported by MRI or CT imaging to identify the exact level and severity of narrowing. Imaging alone is not the diagnosis — a great many people have radiographic stenosis without symptoms — so we correlate what the scan shows with what you feel.

Because Remix Medical is a multispecialty group on one shared record, your pain physician, your primary care doctor, and your chiropractor see the same imaging and the same plan.

Approach	What it involves
Flexion-based physical therapy	Flexion-based exercise, core conditioning, and activity pacing — the measures that most reliably ease claudication
Medication management	Nerve-pain agents and anti-inflammatories
Epidural steroid injections	Delivered under contrast-enhanced fluoroscopic guidance to reduce inflammation around the compressed nerves
Selective nerve root blocks	Confirm which level is symptomatic and treat it directly
Chiropractic and soft-tissue therapy	Available in-house alongside the therapy program
Surgical coordination	Referral for decompression when symptoms are disabling or weakness is progressing — almost always an elective decision

Signs & symptoms

Signs and symptoms to watch for

Leg pain, cramping, or heaviness that worsens with standing and walking
Relief on sitting or leaning forward over a cart or counter
Numbness or tingling in the buttock, leg, or foot
Weakness in the legs or a sense that they may give out
Numbness or clumsiness in the hands and arms (cervical stenosis)
Balance and gait changes
Neck or lower back pain and stiffness

When to see a specialist

Should you see a specialist?

See a pain specialist if leg pain or heaviness reliably appears after walking a short distance and eases when you sit or lean forward, or if numbness and weakness are progressing. Seek emergency care for sudden loss of bladder or bowel control, saddle numbness, or rapidly worsening leg weakness — these can indicate cauda equina syndrome.

Treatment options

Possible treatments

Frequently asked

Spinal Stenosis questions, answered

What is spinal stenosis?

It's a narrowing of the spinal canal that puts pressure on the nerves, most often in the lower back or neck. That pressure causes pain, numbness, or weakness, usually with activity.

What are the symptoms of spinal stenosis?

The classic pattern is leg pain, heaviness, or numbness that comes on with walking or standing and eases when you sit or lean forward. Some people can walk farther pushing a cart.

Does spinal stenosis get worse over time?

It tends to progress slowly as the spine ages, though symptoms can wax and wane. Staying active and managing it early helps keep you moving.

How is spinal stenosis treated without surgery?

Flexion-based physical therapy, activity pacing, nerve-pain medications, and epidural steroid injections relieve symptoms for many people. Surgery to decompress the nerves is considered for disabling cases.

Why does leaning forward relieve stenosis pain?

Bending forward opens up the narrowed canal and takes pressure off the nerves. That's why leaning on a cart or counter often eases the leg symptoms.

What is neurogenic claudication?

It's the classic pattern of lumbar spinal stenosis: leg pain, cramping, or heaviness that comes on with standing and walking and eases when you sit or lean forward — over a shopping cart, for instance. That flexion relief is a key clue distinguishing it from vascular claudication and other causes.

Does an abnormal MRI mean I need treatment for stenosis?

Not by itself. Many people have radiographic stenosis without any symptoms, so imaging findings must be correlated with what you actually feel. Treatment targets the specific level causing symptoms, not the scan alone.

When is surgery considered for spinal stenosis?

For disabling symptoms, severe claudication limiting walking to short distances, progressive weakness, or failure of an appropriate course of non-surgical care. Decompression is almost always elective, and non-surgical care carries fewer adverse events.

When is spinal stenosis an emergency?

Sudden loss of bladder or bowel control, saddle numbness, or rapidly worsening leg weakness can indicate cauda equina syndrome and requires immediate care.

Sources

References

Kreiner DS, Shaffer WO, Baisden JL, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J 2013;13(7):734–743 — https://pubmed.ncbi.nlm.nih.gov/23830297/
Bussières A, Cancelliere C, Ammendolia C, et al. Non-Surgical Interventions for Lumbar Spinal Stenosis Leading to Neurogenic Claudication: A Clinical Practice Guideline. J Pain 2021;22(9):1015–1039 — https://pubmed.ncbi.nlm.nih.gov/33857615/
Munakomi S, Foris LA, Varacallo M. Spinal Stenosis and Neurogenic Claudication. StatPearls. NCBI Bookshelf — https://www.ncbi.nlm.nih.gov/books/NBK430872/
Katz JN, Zimmerman ZE, Mass H, Makhni MC. Diagnosis and Management of Lumbar Spinal Stenosis: A Review. JAMA 2022;327(17):1688–1699 — https://doi.org/10.1001/jama.2022.5921
National Institute of Neurological Disorders and Stroke: Low Back Pain — https://www.ninds.nih.gov/health-information/disorders/back-pain
National Institute of Arthritis and Musculoskeletal and Skin Diseases: Spinal Stenosis — https://www.niams.nih.gov/health-topics/spinal-stenosis

SpecialtyPain ManagementICD-10 codeM48.00Associated anatomySpinal canal, lumbar spine, cervical spine, ligamentum flavum, facet joints, nerve roots

Also called Lumbar Spinal Stenosis, Cervical Spinal Stenosis, Central Canal Stenosis, Neurogenic Claudication, Narrowing of the Spinal Canal

This page is for general education and is not a substitute for medical advice from your physician. Contact a Remix Medical clinician about your specific situation.

Updated July 31, 2026. Medically reviewed by Raju Mantena, DO.