Lumbar Spine
Lumbar Spinal Stenosis
Narrowing of the spinal canal causing leg pain, weakness, or numbness — usually worse with standing or walking, better with sitting or leaning forward.
What it is
Lumbar spinal stenosis is age-related narrowing of the spinal canal in the lower back. Thickened ligaments, bone spurs, and bulging discs all crowd the nerve roots that travel from your spine down to your legs.
The classic story is neurogenic claudication: leg pain, heaviness, numbness, or weakness that comes on after walking some distance and improves quickly when you sit down or lean forward over a grocery cart. The shopping-cart sign isn't just folklore — it's diagnostic.
How we approach it
Diagnosis combines history, physical exam, and an MRI of the lumbar spine. The MRI tells us where the narrowing is, how severe it is, and which levels are involved.
Most patients improve with conservative care: physical therapy focused on flexion-based exercises and core strengthening, anti-inflammatory medication, and sometimes an epidural steroid injection that can buy months of relief.
If your walking tolerance is shrinking despite that — fifty yards becomes twenty becomes ten — we talk about decompression surgery. The goal is to restore your walking distance, not to chase pain you only feel in extreme positions.
When surgery is considered
Surgery is considered when your walking tolerance significantly limits your life, when conservative care has been exhausted, or when there is progressive weakness on exam.
For most patients a focused laminectomy (decompression) is enough. For patients who also have instability or slippage at the affected level, we add a fusion. The decision is case-by-case based on your imaging and your exam — there is no one-size-fits-all answer.
Common symptoms
- Leg pain or heaviness with walking that eases with sitting
- Better with leaning forward (over a cart, on a counter)
- Numbness or burning in the legs after standing too long
- Cramping or fatigue in the buttocks and thighs
- Back pain is often present but is rarely the main complaint
Non-surgical options we consider first
- Physical therapy focused on lumbar flexion and core stability
- Anti-inflammatory medication (NSAIDs) as tolerated
- Epidural steroid injection for acute flare or short-term relief
- Activity modification — break up long walks, use a cart
- Weight loss if applicable; smoking cessation always
Related procedures
If surgery is the right next step, the most common procedures for this condition are:
Last reviewed: 2026-05-10· Author: Chad Tuchek, MD · Cotton O'Neil Neurosurgery and Spine Center, Stormont Vail Health
The information on this page is general patient education and is not a substitute for individualized medical advice. For urgent symptoms, call 911 or go to the nearest emergency department. For non-urgent questions, call (785) 368-0767.