The discs become less spongy and less fluid filled with age. This can result in reduced disc height and bulging of the hardened disc into the spinal canal. The bones and ligaments of the spinal facet joints can thicken and enlarge, due to arthritis, also pushing into the spinal canal. These changes cause narrowing of the lumbar spinal canal which is known as spinal stenosis (figure).

Spinal stenosis is like the lime build-up on the inside of a garden hose. Over time, it narrows the diameter of the hose, just as spinal stenosis narrows the spinal canal.

When present, symptoms may include pain or numbness in the back and/or legs, or cramping in the legs. Weakness in the legs may occur. Rarely, bowel and/or bladder problems can occur.

Symptoms are often worse with prolonged standing or walking. Symptoms may come and go, and may vary in severity when present. Bending forward or sitting increases the room in the spinal canal and may lead to reduced pain or completed relief from pain.

X-rays may be ordered that may reveal evidence of narrowed discs and/or thickened facet joints. A magnetic resonance imaging (MRI) study may be obtained for a more detailed evaluation of spinal structures. Or, a computed axial tomography (CAT) scan and/or a lumbar myelogram may be advised for similar improved detail.

Each of these studies can provide information about the presence, location and extent of spinal canal narrowing and nerve root pressure.

These treatments may include anti-inflammatory medications (orally or by injection) to reduce associated swelling or analgesic drugs to control pain.

Physical therapy may be prescribed with goals of improving your strength, endurance and flexibility so that you can maintain or resume a more normal lifestyle.

Spinal injections (such as an epidural injection of cortisone) may be prescribed.

If you have severe persistent pain that is not relieved by other analgesics or NSAIDs, your doctor might prescribe narcotic analgesics (such as codeine) for a short time. Take only the medication amount that is prescribed. Taking a larger dosage doesn't help you recover faster. Side effects include nausea, constipation, dizziness and drowsiness, and use can result in dependency. All medication should be taken only as directed. Make sure you tell your doctor about any kind of medication you are taking -even over-the-counter drugs- and inform your doctor whether or not your medication is working for you.

There are other medications that have an anti-inflammatory effect. Corticosteroid medications-either orally or by injection-are sometimes prescribed for more severe back and leg pain because of their very powerful anti-inflammatory effect. Corticosteroids, like NSAIDs, can have side effects. Risks and benefits of this medication should be discussed with your physician.

Selected spinal injections, or "blocks," may be used to relieve symptoms of pain. These are injections of corticosteroid into the epidural space (the area in the spinal canal surrounding the spinal nerves) or facet joints performed by a doctor with special training in this technique. Depending on response to initial injection, several follow-up procedures may be performed at later dates. Injections are often done as part of a comprehensive rehabilitation and treatment program.

You may also be given specific strengthening exercises for the muscles of the back, abdomen, and legs. Everyday activities can be less challenging if flexibility, strength and endurance are optimized. Your therapist and physician may advise you on how best to incorporate a maintenance exercise program into your life, either at home using simple equipment, or at a fitness facility.

For some individuals with spinal stenosis, home modification and safety will be considered. Perhaps the washer and dryer should be moved to a more convenient location. A bedside commode may be advisable. Bathroom safety devices are prescribed if needed. Strategies for preparing meals, pacing activities and conserving energy may be reviewed. Optimal fitting of assistive walking devices such as canes and walkers may be recommended.

Unless significant or progressive leg weakness develops, or bowel or bladder problems occur, the presence of spinal stenosis by itself usually does not represent a dangerous condition in the adult, Therefore, treatment is aimed at pain reduction and increasing the patient's ability to function.

Nonsurgical treatments do not correct the spinal canal narrowing of spinal stenosis itself but may provide long-lasting pain control and improved life function without requiring more invasive treatment. A comprehensive program may require three or more months of supervised treatment.