Diagnosing Lumbar Spinal Stenosis

Only a doctor is qualified to diagnose lumbar spinal stenosis and rule out other conditions that can cause similar symptoms.

 

Once diagnosed, lumbar spinal stenosis is usually categorized as mild, moderate, or severe—depending on your level of pain and how much it restricts your lifestyle.

 

Below are some of the diagnostic methods your doctor might use:

• Symptom history—Your doctor will likely begin by asking about your symptoms and how they affect your daily routine. The symptoms of lumbar spinal stenosis can vary from one person to another, and change from one day to the next.

• X-ray—Produces an image of the spine that outlines the joints and vertebrae.
• Magnetic resonance imaging (MRI) scan—Uses a large magnet and radio waves to create images of various structures in the body, including detailed images of the soft tissue such as the discs and nerve roots.
• Computed tomography (CT or CAT) scan—Creates three-dimensional, cross-sectional images of the body (often using contrast dye). A CT scan clearly reveals any degenerative changes in the spine.
• Myelogram—Uses a special contrast dye, along with X-rays, to create images of the spine and spinal canal. This type of image offers detailed definition of the nerves.
• Pain assessment—Your level of pain and how the condition impacts your daily life is an important part of the diagnostic process and will help your doctor determine the best treatment for you.

Unrelated Conditions With Similar Symptoms

Only a doctor can accurately diagnosis you with lumbar spinal stenosis. But, learning more about the two conditions below that have similar symptoms can help you discuss your symptoms with your doctor:

Vascular Claudication

People with vascular claudication experience sensations similar to those of neurogenic intermittent claudication, but the causes and methods for short-term relief are very different.¹

How Vascular Claudication Differs From Lumbar Spinal Stenosis

• Vascular claudication is caused by a narrowing of the blood vessels in the legs, which causes the leg muscles to receive too little oxygen because of decreased blood flow.
• Neurogenic intermittent claudication, the clinical name for symptoms of lumbar spinal stenosis, is caused by a pinched nerve in the lumbar spine.

The table below provides a side-by-side comparison of neurogenic and vascular claudication.

Distinguishing Between Neurogenic and Vascular Claudication

	NEUROGENIC CLAUDICATION	VASCULAR CLAUDICATION
Location of pain	Thighs, calves, back, and rarely, the buttocks	Buttocks or calves
Quality of pain	Burning, cramping	Cramping
Aggravating factors	Erect posture, walking, extension of the spine	Any leg exercise
Relieving factors	Squatting, bending forward, sitting	Rest
Leg pulses and blood pressure	Usually normal	Blood pressure decreased; pulses in the legs decreased or absent
Skin/other changes	Usually absent	Often present (pallor, bluish tint to the skin, changes to toenails)
Autonomic changes	Bladder incontinence (rare)	Impotence may occur with other symptoms of vascular claudication

Alvarez J, Hardy R. Lumbar Spine Stenosis: A Common Cause of Back and Leg Pain. American Family Physician 1998: 1825

Peripheral Neuropathy

Peripheral neuropathy results from nerve damage, usually in the hands and feet. It has any number of causes, including diabetes, injury, infection, autoimmune disorders, vitamin deficiencies, and exposure to toxins.

 

The symptoms include the following:

• Pain
• Tingling
• Burning
• Numbness
• Sensitivity to light touch
• Sensation of wearing a tight-fitting stocking or glove

How Peripheral Neuropathy Differs From Lumbar Spinal Stenosis

When symptoms first occur in the legs, they can sometimes be mistaken for lumbar spinal stenosis, but the symptoms differ in these ways:

• Peripheral neuropathy symptoms usually begin in the feet and travel up the legs.
• Lumbar spinal stenosis symptoms usually radiate from the lower back down the legs.

Learn more:

• Treatment of Lumbar Spinal Stenosis

References:

1. Alvarez J, Hardy, R. Lumbar Spine Stenosis: A Common Cause of Back and Leg Pain. American Family Physician 1998: 1825.