Conditions · Carrollwood · Tampa Bay
Spinal Stenosis & Spinal Narrowing
What canal and foraminal narrowing actually mean on your report, why your legs behave differently standing than sitting, and how a doctor trained in spinal MRI interpretation connects the picture to the person.
A radiology report is written for other doctors, not for you. So when yours says central canal stenosis, neuroforaminal narrowing, or effacement of the thecal sac, the words land without a translator, and the internet fills the silence badly. This page is the translator. It also names the pattern behind leg symptoms that build when you stand and walk and settle when you sit. Dr. Bobby Koser, DC, chiropractic physician, completed post-doctoral training in spinal MRI interpretation and clinical correlation, and reviewing the report with the person it belongs to is part of the examination here. Bring yours.
Spinal Stenosis Overview
What the words on your report mean
Stenosis is the medical word for narrowing: on a spine report, less open space than the radiologist expected, with the rest of the phrase saying where. Cervical is the neck, thoracic is the mid back, lumbar is the low back. The report usually names what is taking up the room: a thickened ligamentum flavum, a ligament band along the back of the canal, thickening written as hypertrophy; enlarged facet joints, the paired joints at the back of each level; a bone spur, or osteophyte; a disc bulge or herniation; one vertebra sitting forward of the one below, written as spondylolisthesis; or, in the neck, the small ridged uncovertebral joints.
Spinal stenosis, or spinal narrowing
The plainest version: less open space somewhere in the spine, with everything else in the phrase describing location. It does not say which nerves are affected, or whether any of it matches what you feel.
Also written as: spinal narrowing, narrowing of the spinal canal, a narrowed spinal canal, lumbar spinal stenosis or LSS in the low back, cervical stenosis in the neck, thoracic stenosis in the mid back. Some reports call the canal itself congenital or developmental, or use a phrase like short pedicles; those describe its dimensions rather than something pressing into it, and say nothing about when or how anything changed.
Central canal stenosis
The spinal cord, and the nerve roots below where it ends, run down a bony tunnel through the vertebrae called the spinal canal. Central stenosis describes less room in that tunnel. Reports also call that space the thecal sac, the fluid filled sleeve the nerves sit in, so thecal sac effacement means the sleeve is flattened or indented.
Also written as: canal stenosis, central stenosis, central canal narrowing, spinal canal stenosis, indentation or compression of the thecal sac, crowding of the cauda equina, the nerve bundle below the cord, a reduced AP diameter, the front to back measurement of the canal, or a trefoil canal, the clover shape some canals are said to have.
Foraminal stenosis, or neuroforaminal narrowing
At every level a pair of nerves leaves the canal through small side doorways called foramina, one left and one right. Foraminal narrowing describes less room in one of those doorways, which is why these reports name a side: left and right serve different halves of you.
Also written as: foraminal narrowing, neuroforaminal stenosis or narrowing, neural foraminal narrowing, narrowing of the neural foramen, foraminal or neural foraminal encroachment, neural stenosis, and with a side attached: left, right, or bilateral, which means both. Reports often pair it with the structure alongside, as in facet hypertrophy with foraminal narrowing, or uncovertebral hypertrophy in the neck.
Lateral recess stenosis
Before a nerve turns out through its side doorway it passes through a short gutter along the edge of the canal called the lateral recess. Lateral recess narrowing describes less room in that gutter. It sits between the two terms above, so one report can name all three at one level.
Also written as: lateral recess narrowing, lateral stenosis, subarticular stenosis, or subarticular recess narrowing. Subarticular means underneath the joint.
Neurogenic claudication
Claudication means limping and neurogenic means coming from nerves, so neurogenic claudication is the name for leg or buttock symptoms that build while you stand and walk and settle when you sit down or lean forward. It is the pattern behind leaning on a shopping cart at Publix.
Also written as: pseudoclaudication, neurogenic intermittent claudication, or spinal claudication. Some clinicians call the leaning-forward version the shopping cart sign.
The grading words, and the level numbers
Most reports put a grading word in front of the finding and a pair of numbers after it. The grading word describes how much open space showed on the images. The numbers say which two vertebrae it sits between: L4 to L5 or L5 to S1 in the low back, C5 to C6 or C6 to C7 in the neck.
Also written as: a grading word plus a side plus a level, as in right foraminal narrowing at L5 to S1, or bilateral neural foraminal stenosis at C5 to C6.
A finding is not a diagnosis
In one community study in Japan, researchers scanned 938 adults aged 40 to 93, average age 66.3, 630 of them women, on a mobile MRI unit, and graded by eye, not by measuring millimeters, how much room showed in the central canal. Narrowing was common in that group: 30.4% had narrowing at the study’s highest grade, and among the people at that highest grade, 17.5% also met a published guideline definition for having stenosis symptoms, which means most people at that grade in that study did not.1 Read that in both directions, because both halves are true: a narrowing on your scan is not automatically the reason you hurt, and your pain is not less real because narrowing turns up on other people’s scans too.
The same study reported that narrowing at the highest grade was still associated with having those symptoms after the researchers accounted for age, sex, and body mass index, a number that compares weight to height. It is a snapshot of one group at one moment, so it cannot tell you what produced anyone’s symptoms, and it reported its percentages for the central canal only, not the side doorways. Whether a narrowing explains what you feel depends on where it sits and which nerves it could reach. The report is the starting point. The exam connects it to you.
1. Ishimoto Y, et al. Associations between radiographic lumbar spinal stenosis and clinical symptoms in the general population: the Wakayama Spine Study. Osteoarthritis Cartilage. 2013;21(6):783-788. PubMed
Neurogenic claudication: the pattern behind the shopping cart
The pattern does most of the work. In a systematic review of the tests for lumbar spinal stenosis, covering research published through March 2011, the authors reported that estimates of accuracy differed considerably from one study to the next, and concluded that the field still needs agreement on criteria for defining and classifying the condition. They described MRI as the most promising imaging test, and wrote that tests should be weighed alongside the symptoms carrying the highest diagnostic value, the ones that most point toward the diagnosis. Their list: radiating leg pain, meaning pain that travels down the leg, worse when standing; the absence of pain when seated; improvement when bending forward; and a wide based gait, meaning walking with the feet set wider apart than usual.2
Those are pointers weighed together, not a checklist. Having them does not establish that you have stenosis, and lacking them does not rule it out.
A separate group put the same question to a panel: 279 clinicians from 29 countries, averaging 19 years in practice, agreed through rounds of surveys on seven items from a person’s history to consider when identifying lumbar spinal stenosis: leg or buttock pain while walking; bending forward to relieve symptoms; relief when leaning on a shopping cart or riding a bicycle; motor or sensory disturbance while walking, meaning weakness or a change in feeling as you walk; normal and symmetric foot pulses, meaning the pulse in both feet is present and the same on each side; lower extremity weakness; and low back pain.3 That is expert consensus about what to ask, not a measurement of how often those items turn out to be right.
The picture describes the space. The pattern describes you. Tell whoever examines you how far you get before symptoms start and what changes them, because no scanner records that.
2. de Schepper EI, et al. Diagnosis of lumbar spinal stenosis: an updated systematic review of the accuracy of diagnostic tests. Spine (Phila Pa 1976). 2013;38(8):E469-E481. PubMed
3. Tomkins-Lane C, et al. ISSLS Prize Winner: Consensus on the Clinical Diagnosis of Lumbar Spinal Stenosis: Results of an International Delphi Study. Spine (Phila Pa 1976). 2016;41(15):1239-1246. PubMed
Symptoms, and the warning signs we screen for
Narrowing in the low back tends to speak through the legs, and narrowing named in the neck through the arms, with neck pain, arm pain, or hand changes. Leg symptoms following one nerve down one leg are sciatica, often alongside low back pain.
Leg pain brought on by walking has another possible source: circulation. When the arteries feeding the legs are narrowed, a condition called peripheral arterial disease, walking can bring on calf or thigh pain that eases when you stand still, with no need to bend forward, and it can come with weak, absent, or unequal pulses in the feet, cool feet, or hair loss on the legs. That belongs with a vascular evaluation, one reason foot pulses sit on the consensus list above.
Common, and examined here
- Leg or buttock symptoms that build with standing and walking and settle when you sit or lean forward
- Numbness, tingling, or heaviness in one or both legs
- A walking distance that has been getting shorter
- Neck, arm, or hand symptoms with narrowing named in the neck
- A report saying canal, lateral recess, or foraminal narrowing that nobody has explained to you
Emergency, not an appointment
- New loss of bowel or bladder control, or new trouble starting or stopping urination
- Numbness in the groin, the buttocks, or the inner thighs, the area a saddle would touch
- Rapidly worsening weakness in one or both legs, or a foot that starts dragging or slapping the floor
- New numbness or weakness in both legs at the same time, or new changes in sexual function alongside any of the above
- New clumsiness in the hands, dropping things, or trouble with buttons and keys, especially with unsteady, wide legged walking
Together the first group can signal cauda equina syndrome, compression of the nerve bundle below the end of the spinal cord, which is a surgical emergency. Hand clumsiness with unsteady walking points to the spinal cord in the neck. Either way, go to the emergency department now. So does new numbness or weakness after a fall or a crash. This is part of what the examination here screens for.
How we approach spinal stenosis
The examination comes first, every time, and your imaging report is read with you, not at you. That visit is the Pain Source Exam. Dr. Koser’s post-doctoral training in spinal MRI interpretation and clinical correlation exists for this conversation, and years of helping flag potential surgical cases for referral, alongside neurosurgeons, came before this practice. The question the visit answers: does the narrowing explain the person in the room?
Working that out means mapping which nerves the finding could reach, then testing whether you match the map: what standing, walking, and bending forward do to your symptoms, how far you get before they start, what your strength, reflexes, and sensation show, and whether the leg symptoms behave like a nerve problem or like the circulation pattern above.
When conservative care fits, it is built from that examination: flexion-distraction, which stretches the spine slowly with no thrust, dry needling for the muscles guarding the area, and a plan for movement you can actually follow, monitored so the plan changes if you do not.
When the examination points somewhere else, we say so, refer you to the right physician, and send your records with you. That includes strength lower at a recheck, a new foot drop, bowel or bladder changes of any kind, hand clumsiness with unsteady walking, a walking distance that keeps shrinking through a monitored trial of care, fever or night pain unchanged by position, unexplained weight loss with new spine pain, prior spine surgery or hardware with changed symptoms, and conditions such as known osteoporosis, fragility fracture, blood thinners, or inflammatory arthritis, which may call for medical co-management first. Surgery decisions belong with surgeons; making sure you are in the right room is part of the job here.
Hurt in a car accident? Florida’s PIP law requires care to begin within 14 days. Start at our auto accident page.
What the research shows
Both studies below are randomized trials, studies where people agree to be assigned by chance to one approach or another so the groups can be compared fairly.
In one randomized trial published in JAMA Network Open, researchers assigned 259 adults older than 60, all with narrowing of the central canal or lateral recess confirmed on MRI or CT and with the standing-and-walking leg pattern called neurogenic claudication, to 6 weeks of one of three approaches: medical care from a physiatrist, a rehabilitation physician, using medications, epidural injections, or both; group exercise classes; or hands-on care plus individualized exercise from chiropractors and physical therapists, meaning spinal mobilization, a slow gliding of the joints with no thrust, along with stretches and strength training. The long view first: by 6 months the three groups showed no between-group differences in outcome scores or responder rates, the share of people who improved by a set amount, and all three approaches were associated with improved long-term walking capacity. At 2 months, the hands-on plus individualized exercise group was associated with greater improvement in symptoms and physical function than medical care, an adjusted difference of -2.0 on a questionnaire scored 12 to 55, with a statistical range of -3.6 to -0.4, or group exercise, a difference of -2.4, with a range of -4.1 to -0.8. At that same 2-month mark, a larger share of the hands-on group, 65.3%, had improved their walking capacity by at least 30%, compared with 48.7% with medical care and 46.2% with group exercise, which also means that some people in every group, including that one, did not reach that mark.4
A second randomized trial, published in the Annals of Internal Medicine, enrolled 169 adults aged 50 or older with lumbar spinal stenosis, every one of them a surgical candidate who had already consented to surgery, and assigned them to decompression surgery, an operation that removes tissue to make more room around the nerves, or to a physical therapy regimen. Two things to know about this trial before its result: it had no untreated comparison group, so it cannot say how anyone would have fared with neither treatment, and 57% of the physical therapy group went on to have surgery. Even so, at 2 years the two groups reported similar improvement in physical function, average gains of 22.4 points with surgery and 19.2 with physical therapy on a standard health survey. The trial’s primary comparison, which counts every person in the group they were first assigned to, found no difference between the groups, an estimated 0.9 points with a statistical range of -7.9 to 9.6, a range that includes zero, and analyses accounting for the crossovers found no significant differences either. The authors did not conclude that either option is the right one for everyone. They concluded that patients and their doctors should make this decision together, with full disclosure of the evidence for both surgical and nonsurgical treatment.5
Trials like these report group results, and no group result decides what fits one person; connecting numbers like these to your imaging, your history, and your examination is what the Pain Source Exam is for.
4. Schneider MJ, et al. Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial. JAMA Netw Open. 2019;2(1):e186828. PubMed
5. Delitto A, et al. Surgery versus nonsurgical treatment of lumbar spinal stenosis: a randomized trial. Ann Intern Med. 2015;162(7):465-473. PubMed
Common questions about spinal stenosis
The radiologist graded the narrowing on my report. What does the grade mean?
The grade is the radiologist describing how much open space showed on the images, and the level numbers say which two vertebrae it sits between, like L4 to L5 or C5 to C6. Both describe a picture taken on one day. Whether that location lines up with your symptoms is what the examination works out.
Why do my legs bother me when I stand and walk but settle when I sit or lean on a shopping cart?
That pattern is called neurogenic claudication: leg or buttock symptoms that build while you stand and walk and settle when you sit or bend forward. In the review above, radiating leg pain worse when standing and improvement when bending forward were among the symptoms carrying the highest diagnostic value. They are pointers, not proof, and that review reported accuracy estimates differing considerably between studies.
Why can I ride a bike for an hour but barely walk to the mailbox?
Riding a bicycle keeps you bent forward and walking does not. Relief when leaning on a shopping cart or riding a bicycle is one of seven history items an international panel of 279 clinicians agreed on for lumbar spinal stenosis. That is expert consensus about what to ask, not a test result, and it is worth telling whoever examines you.
What is the difference between canal stenosis and foraminal stenosis on my report?
Canal stenosis describes less room in the main tunnel of the spine. Foraminal stenosis describes less room in one of the small side doorways a nerve uses to leave the spine, which is why those reports name a side: left, right, or bilateral. Lateral recess narrowing describes the gutter just before it. Which one appears changes which nerves sit nearby, and that is what the examination maps.
Is spinal stenosis the same thing as a pinched nerve?
Not quite. Stenosis is a word about space: less room somewhere in the spine. A pinched nerve is a word about a nerve being irritated or compressed, showing up as pain, numbness, tingling, or weakness along its path. Narrowing can sit next to a nerve without matching anyone’s symptoms, and symptoms can follow a nerve’s path for reasons a scan does not show. The examination lines the two up.
Do I need surgery for spinal stenosis?
That decision belongs with a surgeon, and an imaging report alone does not make it. What an examination here works out is whether the narrowing explains what you feel, whether your strength, reflexes, and sensation are holding, and whether what you present with calls for a surgical opinion now. When it does, we say so, refer you, and send your records with you.
Do you adjust people whose report says stenosis?
The examination decides the technique, and these are cases where the gentler tools earn their place: flexion-distraction, which stretches the spine slowly with no thrust, instrument adjusting, and soft-tissue work. Some presentations should not be adjusted at all, and if yours is one of them, we tell you and treat differently or refer.
I was in a car accident and now my report says stenosis. Did the crash do this?
An imaging report describes what is on the images now. It carries no date for how anything got there, and a report alone does not answer that question. What speaks to it is your history, your examination, and what your records show over time, documented from the first visit. If you were hurt in a crash, Florida’s PIP law also requires care to begin within 14 days.
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This page is general health information and is not medical advice for any individual. The studies summarized describe groups, not any one person’s outcome, and whether any finding on your imaging explains your symptoms can only be determined by examination. Talk to Dr. Bobby Koser, DC, about your own situation, and seek emergency care immediately for the warning signs listed above.
Bring the report. Leave knowing what it says.
A complete examination with Dr. Bobby Koser, DC, your MRI report reviewed with you, and your findings explained the same day.