A man complains of lower back pain

Diagnosing Spinal Stenosis

Spinal stenosis is a condition in which the space in the spinal column allowed for the spinal cord and nerves decreases, causing numbness, pain, and weakness. Spinal stenosis typically occurs in the neck region (cervical stenosis) or the lower back (lumbar stenosis), but it does occasionally arise in the middle back (thoracic stenosis). Which type of stenosis is affecting you is often key to accurately diagnosing it. Here’s a look at a few ways doctors figure out what’s going on back there. 

Diagnosis Difficulties

One of the most difficult aspects of diagnosing spinal stenosis is its similarity to other issues that crop up more commonly with age. Most patients with spinal stenosis are over fifty; those who develop it younger are generally born with a spinal column that’s smaller than it should be. Regardless, in addition to a general exam geared toward your issues, one or several imaging tests may be necessary.

First Steps of Diagnosis

The initial steps of diagnosis are very similar to getting a good diagnosis for any other disease. Your doctor should take the time to examine your medical history with you, looking for traumatic incidents, signs of diseases that can cause spinal stenosis, and any other problems that may indicate the condition. This can not only help with diagnosis, but also help figure out a cause of the problem.

A physical examination should follow this. Your doctor will lead you through a series of movements and stretches that indicate how restricted movement is, how extreme the pain, and if there is any additional neurological impairment in the extremities.

Imaging Tests

For an accurate diagnosis, there are a variety of imaging tests that can help properly identify the presence of spinal stenosis, as well as its cause. Your general practitioner may be quite comfortable performing these tests, or it may be necessary to go to a rheumatologist, neurologist, orthopaedic surgeon, or neurosurgeon. The following imaging tests are commonly used for diagnosing spinal stenosis:

  • X-ray: X-rays show not only any bone spurs that may have developed, but also tumors, fractures, calcification. 
  • Bone test: A bone test in tandem with other imaging tests can provide a good view of fractures, arthritis, and other issues. 
  • Magnetic resonance imaging (MRI): An MRI can provide a 3D, cross-sectional view of the spine. This is especially useful when looking at the tissues in the area, rather than bones that can be seen on an x-ray. 
  • Computerized axial tomography (CAT): A CAT scan provides a similar view to that of the MRI, but it looks more closely at the size and shape of the spinal canal. 
  • Myelogram/Computerized tomography (CT): While the CT scan provides the 3D/cross-sectional picture of the spine, a myelogram utilizes a particular dye that outlines but does not permeate the spinal cord and surrounding nerves. This technology allows doctors to see areas where the bone may be pressing on those nerves. 
Last Updated: January 19, 2016