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Spinal stenosis

Last reviewed: 4 Sep 2023
Last updated: 14 Dec 2021



History and exam

Key diagnostic factors

  • onset and duration of symptoms
  • back pain
  • activity-related back pain
  • leg pain when walking
  • stooped posture when walking
  • leg numbness or paresthesias
  • absence of exam findings
More key diagnostic factors

Other diagnostic factors

  • pain radiating down the leg
  • bladder or bowel dysfunction
  • muscle weakness or wasting
Other diagnostic factors

Risk factors

  • age over 40 years
  • manual labor
  • previous back surgery
  • family history of back pain
  • smoking
  • diabetes mellitus
  • peripheral vascular occlusive disease
  • previous injury
  • achondroplasia
  • acromegaly
More risk factors

Diagnostic investigations

1st investigations to order

  • plain x-ray
  • MRI (T2-weighted)
More 1st investigations to order

Investigations to consider

  • CT myelography
  • CT spine
  • electromyographic (EMG) walking test
  • electromyographic paraspinal mapping
More investigations to consider

Treatment algorithm


significant acute neurologic deficit

no significant acute neurologic deficit: pain affecting quality of life and/or functional activities


chronic symptoms



Michael David Tseng MD, MD

Clinical Assistant Professor

Department of Orthopaedic Surgery

Stanford University School of Medicine




MDT declares that he has no competing interests.


Dr Michael David Tseng would like to gratefully acknowledge Dr Adam M. Pearson, Dr William A. Abdu, Dr John K. Houten, and Dr Mark Chwajol, previous contributors to this topic. WAA is an author of a reference cited in this topic. JKH and MC declare that they have no competing interests.


WAA and AMP are authors of references cited in this topic. JKH and MC declared that they had no competing interests.

Peer reviewers

John Ratliff, MD, FAANS, FACS

Associate Professor

Department of Neurosurgery

Stanford University




JR declares that he has no competing interests.

  • Differentials

    • Peripheral vascular disease
    • Lumbosacral intervertebral disk herniation
    • Spinal compression fracture
    More Differentials
  • Guidelines

    • Natural course and diagnosis of lumbar spinal stenosis: WFNS Spine Committee recommendations
    • ISSLS prize winner: consensus on the clinical diagnosis of lumbar spinal stenosis: results of an international delphi study
    More Guidelines
  • Patient leaflets

    Spinal stenosis

    More Patient leaflets
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