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Spinal Stenosis: Diagnostic Process

Stewart G. Eidelson, MD
SpineUniverse Founder, Orthopaedic Surgeon
Asst. Professor - Univ. of Miami at FAU
South Palm Orthospine Institute
Boca Raton, FL
How is Spinal Stenosis diagnosed?
Similar to other medical disorders, the diagnostic process for spinal stenosis includes a complete patient history, and physical and neurological examination. You will be asked to describe your symptoms, when the condition started, activities that aggravate or alleviate symptoms, and the result of previous medications taken and therapies tried to treat the disorder.

During the physical and neurological examination the doctor will feel your spine and test your reflexes. Further, he will test your balance while watching you walk normally, on tip toes and heels. To determine how much motion you have in your spine, you may be asked to bend forward, backward, and side to side. These and other movement and reflex tests help to rule out loss of extremity reflexes, muscle weakness, and loss of feeling. The extremities are your arms and legs.

Can the doctor tell it is Spinal Stenosis just from an examination?
Depending on doctor's findings, other tests may be needed to confirm the diagnosis. These tests include:

X-Ray: An x-ray is the most common test performed and shows the structure of the spinal bones (vertebrae) and can detect bone spurs.

x-ray, burst fracture

Sample X-Ray detects a spinal fracture.

MRI (Magnetic Resonance Imaging): MRI provides a highly detailed, three-dimensional image of the spine. The spinal cord, nerve roots, and spaces are clearly defined.

mri, burst fracture

Sample MRI detects a spinal fracture.

CAT Scan (Computerized Axial Tomography): A CAT Scan renders images of bone better than nerves and is often used to show the shape and size of the spinal canal.

ct scan, burst fracture

Sample CAT Scan detects a spinal fracture.

Myelogram: Using x-ray and a special liquid dye that is injected into the patient intravenously, a myelogram helps to define where there is pressure on the spinal cord or nerve roots from a herniated disc, bone spurs, or a tumor (rare).

Bone Scan: This safe test uses a radioactive material that is injected into the patient. The material attaches itself to bone and helps to detect fractures, tumors, infections, and osteoarthritis. The doctor usually relies on other tests in conjunction with a bone scan.

bone scan
Sample Bone Scan.

Last Updated: 12/28/2007
Continue Reading: Spinal Stenosis: Non-Operative Treatment
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Editorial Board Comments on SpineUniverse
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Peer Review by Leading Specialists

    Howard S. An, MD

    I had a great pleasure reading Dr. Stewart Eidelson's 5-part article on spinal stenosis. The information included in this article is accurate and informative. I would like add a few comments for the benefit of the readers or potential patients. First, spinal stenosis is indeed most common in the lumbar spine, followed by the cervical spine. However, occasionally, the thoracic spine is affected as well. Spinal stenosis in the thoracic spine can present with pain radiating around the rib (thoracic radiculopathy) or numbness, spasm, and weakness of the legs (myelopathy). Sometimes, lumbar stenosis and cervical stenosis co-exist, and the astute doctor will pickup both diagnoses and render appropriate treatment for both conditions. Also, leg symptoms and walking difficulty may be due to clogging of the leg vessels (vascular claudication) rather than due to lumbar spinal stenosis (neurogenic claudication). Sometimes, both vascular and neurogenic claudication conditions may co-exist. Again, making the correct diagnosis is important for subsequent treatment.

    As Dr. Eidelson mentioned, lumbar stenosis is largely due to "wear and tear" or degenerative changes in the joints and intervertebral discs in the spine over many years, but some patients are born with smaller spinal canal (congenital stenosis). Congenital stenosis patients typically show symptoms in their 40s and 50s rather than in their 60s and beyond. Because of smaller canals at birth, minor bulging discs and degenerated joints tend to affect the nerves earlier in life in these patients. Some patients with congenital stenosis may undergo discectomy alone without decompressive procedures for the narrowed canal, and surgical outcomes may be compromised. Again, correct and precise diagnosis leads to correct treatment.

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