Symptoms of Central Canal Stenosis

There are a number of potential symptoms of central canal stenosis, and one's specific symptoms are mostly determined by the location and severity of the stenosis in the spine. A burning or sharp pain, numbness, and/or weakness may be experienced in the neck, shoulder, arms, and/or the lower body.

Typically, both sides of the body are affected in central stenosis, although the symptoms and/or signs may not always be symmetrical. Sometimes, one-sided symptoms may also be seen.¹Cowley, P. (2016). Neuroimaging of Spinal Canal Stenosis. Magnetic Resonance Imaging Clinics of North America, 24(3), 523–539. https://doi.org/10.1016/j.mric.2016.04.009^,2Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. January 2016:h6234. doi:10.1136/bmj.h6234 The symptoms and signs of central stenosis specific to different locations in the spine are discussed below.

Lumbar Central Canal Stenosis Signs and Symptoms

Stenosis of the lumbar spine occurs almost 4 times more compared to other spinal levels.³Melancia JL, Francisco AF, Antunes JL. Spinal stenosis. In: Handbook of Clinical Neurology. Elsevier; 2014:541-549. doi:10.1016/b978-0-7020-4086-3.00035-7 The symptoms usually occur in the lower back, buttocks, thigh, calf, and/or legs.

Some symptoms appear first, followed by advanced symptoms later. In some instances, these symptoms may fluctuate.

Early symptoms of lumbar central canal stenosis

In the initial stages, lumbar central canal stenosis may cause:

• A dull ache to sharp pain in the hips and back of the thighs. Sometimes, the legs and feet may be affected.²Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. January 2016:h6234. doi:10.1136/bmj.h6234^,4Omidi-Kashani F, Hasankhani EG, Ashjazadeh A. Lumbar spinal stenosis: who should be fused? An updated review. Asian Spine J. 2014;8(4):521–530. doi:10.4184/asj.2014.8.4.521
• Stiffness and/or a locked feeling in the lower back, usually felt soon after waking in the morning.⁴Omidi-Kashani F, Hasankhani EG, Ashjazadeh A. Lumbar spinal stenosis: who should be fused? An updated review. Asian Spine J. 2014;8(4):521–530. doi:10.4184/asj.2014.8.4.521^,5Deasy J. Acquired lumbar spinal stenosis. Journal of the American Academy of Physician Assistants. 2015;28(4):19-23. doi:10.1097/01.jaa.0000462052.47882.fd

These symptoms typically remain constant without progression for a long time and may also improve gradually in some people.²Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. January 2016:h6234. doi:10.1136/bmj.h6234 If the stenosis worsens, more symptoms and signs may develop.

Advanced symptoms and signs of lumbar central canal stenosis

As lumbar central canal stenosis progresses, the condition may include⁵Deasy J. Acquired lumbar spinal stenosis. Journal of the American Academy of Physician Assistants. 2015;28(4):19-23. doi:10.1097/01.jaa.0000462052.47882.fd:

• Burning pain in both legs that typically begins after starting to walk or after standing for prolonged periods of time—pseudo-claudication or neurogenic claudication
• Heaviness, cramping, and numbness in the legs
• ‘Foot-drop’ or difficulty in lifting the foot while walking or attempting to walk
• Reduced bowel and/or bladder control, more often affecting the bladder

Lumbar stenosis pain typically increases while bending the body backward and decreases while bending forward or sitting.⁵Deasy J. Acquired lumbar spinal stenosis. Journal of the American Academy of Physician Assistants. 2015;28(4):19-23. doi:10.1097/01.jaa.0000462052.47882.fd^,6Genevay S, Atlas SJ. Lumbar spinal stenosis. Best Pract Res Clin Rheumatol. 2010;24(2):253–265. doi:10.1016/j.berh.2009.11.001 For this reason, patients are often seen leaning over shopping carts or walking with their legs apart in order to relieve pain.²Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. January 2016:h6234. doi:10.1136/bmj.h6234^,7Ammendolia C. Degenerative lumbar spinal stenosis and its imposters: three case studies. J Can Chiropr Assoc. 2014;58(3):312–319. When spinal cord compression in the lumbar spine results in verifiable neurological deficits, such as numbness or weakness, it is called lumbar claudication with radiculopathy.

See Lumbar Spinal Stenosis Symptoms

Cauda equina syndrome

Rarely, the development of cauda equina syndrome is possible as a result of stenosis occurring along with disc herniation in the same level of the lumbar spine. The condition typically causes:

• Loss of bowel and bladder control
• Severe back and leg pain
• Leg weakness
• Saddle anesthesia (numbness in the genital and groin area)

Cauda equina syndrome is considered a medical emergency and must be treated on an urgent basis.⁸Johnsson K-E, Sass M. Cauda Equina Syndrome in Lumbar Spinal Stenosis. Journal of Spinal Disorders & Techniques. 2004;17(4):334-335. doi:10.1097/01.bsd.0000095828.98982.6c

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Cervical Central Canal Stenosis Signs and Symptoms

Research shows that the signs and symptoms of stenosis in the cervical spine varies widely and usually worsens with time. It is possible for the signs and symptoms to disappear for extended periods and then reappear suddenly.⁹Meyer F, Börm W, Thomé C. Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment. Dtsch Arztebl Int. 2008;105(20):366–372. doi:10.3238/arztebl.2008.0366

Early symptoms and signs of cervical central canal stenosis

The initial symptoms and signs of cervical central canal stenosis include⁹Meyer F, Börm W, Thomé C. Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment. Dtsch Arztebl Int. 2008;105(20):366–372. doi:10.3238/arztebl.2008.0366:

• Mild to moderate burning or shock-like pain in the neck, shoulder, and/or arms
• Abnormal sensations such as tingling, crawling, and/or numbness in the hands
• Difficulty in doing tasks that involve fine motor skills of the hand, such as buttoning a shirt
• Difficulty in maintaining balance while walking, especially in the dark

Often, headaches and position-induced pain may interfere with sleep.¹Cowley, P. (2016). Neuroimaging of Spinal Canal Stenosis. Magnetic Resonance Imaging Clinics of North America, 24(3), 523–539. https://doi.org/10.1016/j.mric.2016.04.009 With the progression of spinal cord damage, more symptoms may develop in the arms and/or other parts of the body.

Advanced symptoms and signs of cervical central canal stenosis

Progressive symptoms and signs of cervical central canal stenosis include:

• Difficulty with writing, eventually making holding a pen impossible⁹Meyer F, Börm W, Thomé C. Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment. Dtsch Arztebl Int. 2008;105(20):366–372. doi:10.3238/arztebl.2008.0366
• Severe shooting, electric shock-like pain in the arms and upper body, especially when the head is moved⁹Meyer F, Börm W, Thomé C. Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment. Dtsch Arztebl Int. 2008;105(20):366–372. doi:10.3238/arztebl.2008.0366
• Gait imbalance

Worsening of neurological deficits are seen in almost 75% of cases of cervical stenosis. The injury may become irreversible if the spinal cord is severely affected.⁹Meyer F, Börm W, Thomé C. Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment. Dtsch Arztebl Int. 2008;105(20):366–372. doi:10.3238/arztebl.2008.0366 When spinal cord compression in the cervical spine results in verifiable neurological deficits, such as numbness or weakness, it is called cervical myelopathy.

See Symptoms of Cervical Stenosis with Myelopathy

Thoracic Central Canal Stenosis Symptoms

Stenosis of the thoracic spine is rare and accounts for less than 1% of spinal stenosis cases. When it occurs, it usually affects the lower thoracic spine (T10-T12) and may coexist with lumbar stenosis.¹⁰Garry JP. A Rare Case of Thoracic Spinal Stenosis in a White Male. Current Sports Medicine Reports. 2018;17(1):13-15. doi:10.1249/jsr.0000000000000440^,11Fushimi K, Miyamoto K, Hioki A, Hosoe H, Takeuchi A, Shimizu K. Neurological deterioration due to missed thoracic spinal stenosis after decompressive lumbar surgery. The Bone & Joint Journal. 2013;95-B(10):1388-1391. doi:10.1302/0301-620x.95b10.31222

Mostly, the symptoms of thoracic stenosis are similar to lumbar stenosis. As the stenosis of the thoracic spine advances, severe symptoms and signs of muscle weakness are seen in the legs, mainly in the thigh and shin regions.¹⁰Garry JP. A Rare Case of Thoracic Spinal Stenosis in a White Male. Current Sports Medicine Reports. 2018;17(1):13-15. doi:10.1249/jsr.0000000000000440 A higher level of thoracic stenosis can cause one half of the torso to feel different by temperature and sensation compared to the other half.

The treatment of central canal stenosis focusses on the underlying problem, such as bone spurs (osteophytes), herniated discs, or other causes. It is advisable to seek medical attention as soon as possible if central canal stenosis is suspected.

See When Back Pain May Be a Medical Emergency