Diagnosing spinal stenosis can be challenging. The symptoms can mimic those of other conditions, plus the symptoms can come and go. To figure out the cause of your spinal stenosis, your doctor will need to perform several exams and tests. These exams and tests will also help the doctor develop a treatment plan for you—a way to manage your pain and other symptoms and to help you recover.

During your visit, your doctor will ask about your current symptoms and remedies you have already tried.  This is part of your physical exam. He or she will ask some typical questions, such as:

• When did the pain start?
• What activities did you recently do?
• What have you done for your pain?
• Does the pain radiate or travel to other parts of your body (eg, down your arm or down your leg)?
• Does anything reduce the pain or make it worse? Specifically, does walking downhill make it worse or better? What happens to your pain when you lean forward or sit down?

Imaging Tests for Spinal Stenosis

You may also need to have some imaging tests done to help your doctor diagnose the cause of your spinal stenosis.  These diagnostic studies are usually performed if symptoms do not subside after a period of 3 to 6 months of therapy such as rest, anti-inflammatory medications, and physical therapy.

Imaging tests are ordered cautiously because many people who do not have any symptoms of spinal stenosis have abnormal x-rays, CT scans, and MRIs. Surgery should only be performed in patients whose symptoms correlate with findings on these studies and a history that supports these findings.

Typically, plain x-rays are done first. They are helpful in looking for infection, tumors, and identifying problems with alignment of the spine.  They can show narrowed disc space, fractures, bone spurs (osteophytes), or osteoarthritis (spondylosis).

A computerized axial tomography scan (a CT or CAT scan) or a magnetic resonance imaging test (an MRI) can show a bulging disc or a herniated disc.  An MRI image is shown below.

You also may be asked to undergo additional tests, such as:

• bone scan: This will help your doctor detect spinal problems such as osteoarthritis, fractures, or infections. You will have a very small amount of radioactive material injected into a blood vessel. That will travel through your bloodstream and be absorbed by your bones. More radioactive material will be absorbed by an area where there is abnormal activity—like inflammation. A scanner can detect the amount of radiation in all your bones and show the "hot spots" (the areas with more radioactive material) to help your doctor figure out where the problem is.
• CT myelogram: In this test, you'll have a special dye injected into the spinal fluid around your spinal cord and nerves. (Before that happens, the area will be numbed.) Then you'll have a CT scan done. The image will provide a detailed anatomic picture of your spine, especially of the nerves and the surrounding bone. The doctor will look for areas of compression, or pressure, on the nerves.  CT scans done in conjunction with myelography are particularly helpful diagnosing lumbar spinal stenosis.  A CT myelogram image is shown below.

All of this information—the physical exam and the imaging tests—will help your doctor plan how best to treat your spinal stenosis.