Stenosis of the lumbar canal

When the spinal canal of the lumbar spine narrows, it is referred to as stenosis of the lumbar canal.

What is the spinal canal like?

The spinal canal, also called the vertebral canal, is space inside which the spinal cord passes, from the first cervical vertebra (called C1) to the first lumbar vertebra (L1), together with the nerve roots, with which the canal ends (at the level of the sacral vertebrae).

The medulla is part of the Central Nervous System together with the brain. The nerve roots, on the other hand, are part of the Peripheral Nervous System, which is involved in the stenosis of the lumbar canal.

Delimited above from vertebral bodies and intervertebral discs, laterally from the vertebral foramina e later from the ligament bone arch, the lumbar spinal canal contains the roots of the sciatic and crural nerves, directed towards the lower limbs. If compressed, the nerve roots cause particularly annoying symptoms.


Lumbar canal and vertebrae
Lumbar canal

The causes of lumbar canal stenosis

This pathology originates above all in a very natural condition: advancing age and the consequent arthritic alterations, which cause a thickening of the lumbar canal walls and a decrease in available space. It is therefore no coincidence that lumbar canal stenosis occurs especially in people over 60-70 years of age. Other causes can be:

  • Lumbar disc herniation
  • spinal tumors, whose masses can occupy the space intended for the medulla
  • trauma to the spine
  • lumbar spondylolisthesis, which alters the positioning of the lumbar vertebrae
  • Paget's disease, which causes bone regeneration too fast, resulting in deformity  

There are also more particular cases, in which the person it was born already characterized by a narrower stretch of the spinal canal of the norm: the symptoms therefore tend to present themselves well before advanced age. There are also some risk factors to consider: according to studies, people suffering from obesity or diabetes mellitus, As well as smoking, are more predisposed to the development of the pathology. 

Lumbar canal stenosis: symptoms

As the nerve roots in the canal gradually deteriorate, symptoms gradually develop. Among the initial ones are: 

  • backache
  • pain in the buttocks, which grows when walking or standing upright and fixed
  • night cramps in the legs

As months and sometimes years go by, the following also manifest themselves:

  • claudication (reduction of driving range)
  • numbness and pain in the legs, which often force the person to stop while walking

The patient experiences a modicum of relief by stopping or bending forward: this is because the position allows the diameter of the spinal canal to increase by about 10%, so that the compression also decreases. This is why many people suffering from lumbar canal stenosis can cycle for entire kilometers, but paradoxically they can only walk for 10-20 meters. 

low back pain
leg cramps

How is a diagnosis made?

Despite the difficulties described, the patient often does not offer other particular signs during the physical examination. It is therefore essential for the diagnosis to resort to one magnetic resonance of the lumbar tract, which allows to detect the presence of the pathology and possibly associate it with others. You can also perform:

  • x-ray of the spine
  • TAC, especially to analyze the bone components
  • electromyography, to measure the functionality of the nerves
Stenosis of the lumbar canal
Magnetic resonance
Stenosis of the lumbar canal

Lumbar canal stenosis: therapy and intervention

To deal with lumbar canal stenosis with the right therapy, it is always necessary to rely on the individual situation of the patient. You can opt for one conservative therapy as well as for a surgery. The first way is preferable if the symptoms are not disabling or if there are no serious pathologies among the causes. Conservative treatment includes pharmacological treatments (with anti-inflammatory-analgesic and muscle relaxant drugs), physical rehabilitation (exercises to strengthen muscles, motor activities in water, stretching and exercise bikes, manual, postural and instrumental therapies) and lifestyle modification (stop smoking, regular physical movement, weight control). 

If these therapies do not give the desired outcome, the lumbar canal stenosis can be treated through surgery, which provides forenlargement of the spinal canal through the removal of the occluded tract. It is possible to perform it with different methodologies, the opportunity of which is carefully evaluated by the neurosurgeon:

  • laminectomy (bilateral approach)
  • hemilaminectomy (one-sided approach)

Thanks to minimally invasive techniques, it is possible to decompress the canal without subjecting the tissues to excessive trauma, to the advantage of recovery times. In addition, a method of endoscopic decompression, further advantageous from this point of view, but not suitable for all types of stenosis.

Following the surgery, it is recommended to undertake a path of physiokinesitherapy (FKT), the practice that in physiotherapy involves motor rehabilitation activities. 


Senior Consultant Neurosurgeon, specialist in Cerebral, Vertebral minimally invasive and pediatric surgery, at the Maria Cecilia Hospital in Cotignola, the Piccole Figlie Hospital in Parma and the Domus Nova in Ravenna, highly specialized hospitals, accredited by the NHS and affiliated with most of the international insurance circuits .

Secretariat: open from Monday to Friday from 09:30 to 13:00 and from 15:00 to 18:00

 +348 916 3317

Studies: Milan, Rome, Naples, Caserta, Bari, Mola di Bari, Domegge di Cadore, Ravenna, Castrocaro Terme, Fermo.

Related post

Stenosis of the cervical canal and myelopathy

La stenosis of the cervical canal is due to narrowing of the cervical tract of the spinal canal, or vertebral, resulting in compression of the medulla within it. This condition is in turn the most frequent cause of cervical myelopathy.

The structure of the neck and spinal canal

The vertebral column, or backbone, is a fundamental element of our body, as it passes through most of it. It is a ductile structure, in which the cervical spine corresponds to the neck area. This consists of seven vertebrae: between each of these there are i intervertebral discs, which allow the spine to move smoothly. Inside the column is the spinal canal, formed anteriorly by the vertebral body, while the laminae constitute its posterior arch. The channel is responsible for protecting the spinal cord and the nerve bundles. The medulla is in turn immersed in the cerebrospinal fluid and is further protected by the three layers of the meninges. At each vertebral level, two spinal nerves exit through the conjugation foramina, allowing the Central Nervous System (which also includes the brain) to communicate and receive information from the body's tissues, muscles and skin. 

The causes of stenosis of the cervical canal

As in the case of stenosis of the lumbar canal, and especially advancing age to cause cervical stenosis. In fact, with the passage of time the vertebral discs eventually become dehydrated (disc disease) and are no longer able to fulfill their function as shock absorbers and the mobility of the cervical spine. This is why the space available between the vertebrae decreases, causing protrusions of the discs in the vertebral canal and sometimes a misalignment or even a real anomalous movement between the vertebrae (spondylolisthesis). At the same time, i ligaments that form the spine lose flexibility and become stiff and thick as new bone develops abnormally (osteoarthritis).

All these changes combine to cause a narrowing of the spinal canal, which occurs mainly in people with more than 50 years of age. In addition to natural aging, there may be other causes of cervical canal stenosis:

  • Cervical disc herniation
  • trauma to the spine
  • spinal tumors, which can compress the spinal cord
  • ossification of the posterior longitudinal ligament (more common in Japan)
  • Paget's disease, which is manifested by skeletal deformities
  • congenital malformations, in which the spinal canal is already narrow from birth

Among the risk factors to be considered are heavy work, with heavy lifting, repeated gestures, bad back postures,obesity, diabetes mellitus and smoke

A serious complication: cervical myelopathy

Cervical stenosis is itself the primary cause of cervical myelopathy, a disease involving the first part of the spinal cord. However, it is not the only possible origin: myelopathy can also be caused by cervical spondylosis, slipped disc, inflammation of the marrow or vascular pathologies in the same area. Its development is slow and gradual and does not necessarily involve a typical symptom of stenosis: neck pain. But it is essential to recognize its presence, also to avoid injury to the nerve cells of the spinal cord.

Stenosis of the cervical canal and myelopathy: symptoms and consequences

We should not underestimate the fact that cervical stenosis can be both symptomatic and asymptomatic. In the first case, the symptoms can be constantly present and gradually more and more intense, but also present themselves in an acute way and then remain silent for a certain period. The characteristic symptoms are: 

  • neck pain
  • burning or pain in the shoulders, upper limbs, lower limbs, buttocks


Typical of stenosis-related cervical myelopathy are these symptoms:

  • tingling and numbness in the limbs
  • weakness of the limbs and hands
  • balance disorders
  • difficulty walking

There are particularly serious cases in which cervical stenosis can negatively affect intestinal and urinary functions, so much so that the patient can lose control of the anal or bladder sphincter (incontinence). It can also occur with quadriplegia, a form of paralysis that affects the torso and limbs.

Diagnosis of stenosis of the cervical canal

Fundamental to start a diagnostic process is the physical examination by the doctor, based on the symptoms described by the patient, combined with the study of his health condition, family history and lifestyle. But above all the role of diagnostic imaging is essential, through these tests:

  • x-ray of the spine to identify possible alterations of the vertebrae
  • magnetic resonance, to study the tissues of the involved area, evaluate the compression of the spinal cord and nerves, and detect any hernias
  • TAC, which guarantees extremely detailed images at the bone level of the area, seeing the osteophytes (osteoarthritis)


Stenosis of the cervical canal: treatment and intervention

Based on each subjective situation, the neurosurgeon evaluates which type of treatment is the most effective for addressing the stenosis of the cervical canal. Surgery is not necessarily the first choice. If the patient is in old age, does not suffer from serious diseases and the symptoms are not disabling, it is indeed advisable to opt for a conservative treatment, aimed at improving the quality of life, which can also keep the symptoms of cervical myelopathy under control. They can then be administered NSAID drugs or corticosteroids, as they are recommended specific exercises for strengthening the muscles and flexibility of the cervical spine. The functional rest, that is, refraining from all movements that precede the painful sensation. 

However, if conservative treatment fails or if the symptoms are disabling, the neurosurgeon may recommend proceeding with a surgery. In particular, the operation is indicated if progressive neurological symptoms occur in the limbs or balance and walking disorders. Different intervention methods are available:

  • laminectomy decompressive
  • laminoplasty
  • vertebral arthrodesis (spinal fusion)
  • discectomy and anterior arthrodesis
  • foraminotomy

After the operation, the patient should act on their lifestyle, especially if they are smokers or overweight.