For most patients, the evaluation of spinal stenosis begins with a comprehensive physical and neurological examination followed by confirmatory imaging tests (An X-ray or MRI scan). The tests provide valuable information about the cause of your spinal stenosis and confirm your doctor’s diagnosis.
Medical History, Symptoms, Examinations
To diagnose your pain as spinal stenosis, your doctor or spine surgeon may ask you questions regarding your symptoms and medical history. Some spinal disorders may be inherited, or risk increasing if a parent has a history of neck or back pain.
Here are examples of questions your doctor may ask about your symptoms:
- Describe your symptoms (including pain, numbness, or tingling sensations)
- When did your symptoms start?
- Where is your pain?
- What is the frequency of your symptoms?
- On a scale from 1 to 10, how do you rate your pain now?
- What improves your symptoms? What makes your symptoms worse?
- Does leaning forward or sitting relieve the pain?
- What treatments have you tried and how did they help?
Your doctor will most likely also ask about:
- existing medical problems (such as diabetes, hypertension and high cholesterol levels)
- current medications (over the counter, prescription and alternative)
- previous spine treatments and surgeries
- lifestyle (alcohol and tobacco use, exercise)
A physical exam may also be conducted for your doctor to get a better understanding of how pain has affected your ability to move.
A typical examination may include all or some of the following elements:
- Assessment of your height, weight and vitals
- Inspection of your skin
- Examination of your breathing and your abdomen
- Examination of your gait (the way you walk) and your posture
- Examination of the contour of your spine
- You may be asked to bend forward and backward, and to bend from side to side as far as possible. You may also be asked to rotate your neck in each direction. Your doctor may place hands on your hips or shoulders to stabilize your body and examine your range of motion.
- Your doctor may apply light pressure to your spine to locate and document areas of tenderness or spasms and assess for any masses or swelling.
- You may be asked to raise or extend your legs from a sitting or lying position. This helps to assess for nerve root tension. Your doctor may assist you by gently raising the leg. You’ll be asked to note the point at which you experience pain as your leg is raised.
- This test can help pinpoint the affected nerves and determine if there is a problem with one of your discs.
Your doctor may ask your questions during your neurologic examination. Here are some examples of topics they will touch on:
- Difficulty walking, climbing stairs, walking downhill
- Weakness in your arms or leg
- Cramps in your legs
- Muscle twitching
- Impaired bowel or bladder function
During the neurological examination your doctor will test your reflexes, sensation, and motor strength. Sensation is assessed by gently touching a pin to the skin and is usually tested in both your arms and legs.
Diagnostic Testing for Spinal Stenosis
In addition to the preliminary questions and the physical and neurological examination, your spine surgeon may recommend imaging tests to confirm the diagnosis and the underlying cause of spinal stenosis.
These may include:
X-rays are a first-line imaging test performed for spinal stenosis. An X-ray is used to take a detailed picture of your bones. Your doctor may use this to detect loss of disc height in your spine, fracture or bone growth, all of which can reduce the size of the spinal canal or spinal nerve passageways and lead to compression.
Magnetic Resonance Imaging (MRI)
MRIs have become the most frequently used study to diagnose spinal stenosis. The MRI uses magnetic signals to produce images of the spine. MRIs show more structures, including nerves, muscles, and ligaments than X-rays or CT scans. MRIs are helpful at showing exactly what is causing pressure on the nerves of the spine, and the precise location of the issue.
Computerized Axial Tomography (CT) or CAT scan
A CT scan is also similar to an X-ray but sometimes a more detailed imaging study is needed to evaluate your spine’s anatomical structures (bones, discs, ligaments and nerves). CT scans may also provide your doctor with a good view of areas of compression within the spinal canal.
Electromyogram & Nerve Conduction Study
Electromyograms and nerve conduction studies measure how well electrical impulses are moving along nerve tissue. This test measures how the nerves that originate in your spine are functioning. This can help pinpoint the location of the nerve damage.
Bone Scintigraphy (Bone Scan)
This option can help look for problems that may be related to spinal stenosis. It is performed by injecting radioactive material into a vein, which is attracted to areas of high bone activity (fractures, tumors, infections, and other potential causes of spinal stenosis).
A myelogram is a special version of an X-ray that uses dye to highlight your nerves. The dye is injected into your back through a spinal tap. The dye shows up on X-rays around these nerves unless there is no space surrounding the nerves. It can help your doctor determine whether the nerves are being compressed. Myelograms are ordered much less these days because of an increased use of MRIs.
A Doppler Ultrasound uses reflected sound waves to measure blood as it flows through a vessel. Your doctor may use this to rule out artery disease.
Blood tests may be ordered to help diagnose the cause behind the spinal stenosis (for example, a bone disease) or rule out other potential diagnoses.
Disclaimer – All information is for educational pursuit and information purposes only. It is not intended nor implied to be a substitute for professional medical advice. The viewer should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding their medical condition, diagnosis, procedures, treatment plan, or other health related topics.