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spinal stenosis pain in legs

spinal stenosis pain in legs

It causes more pain while standing, rather than sitting. Of course, it may be present. Spinal stenosis, involving pressure on either the central spinal cord or nerve root exiting the spinal canal, can cause a variety of symptoms in the lower extremities. If you have lumbar spinal stenosis, you may have trouble walking distances or find that you need to lean forward to relieve pressure on your lower back. I’m Dr. Stephen Hochschuler, co-founder of the Texas Back Institute. Pain. Yoga and Pilates may help with this, with an added benefit of core strengthening to help better support the spine. Choose the wrong ones, and you’re going to make your back sore and bring on leg pain even quicker than before. Failure to address the symptoms will lead to a lifestyle filled with numbness, pain… Lumbar spinal stenosis can cause pains in the lower extremities (legs and thighs) which worsen with walking and are relieved with resting (mimicking poor circulation). Spinal stenosis is a condition that occurs most commonly in the neck and lower back, and is a result of a narrowing of the spinal canal. Restoring health to the pinched nerves and reducing leg pain; I think the above constitutes a pretty compelling argument for having a good exercise program for spinal stenosis! So one can differentiate spinal stenosis and pain down one’s leg, associated with narrowing of the canal, as compared to pain down your leg from a vascular problem in that when you have it from a vascular problem, any exercise hurts. Causes . This process puts added pressure on the spinal cord and nerves in the spine. According to the American Academy of Orthopaedic Surgeons, it usually occurs in people over 60 years old. Extra weight puts more pressure on the spine. The narrowing of the space causes constriction on the nerves, which may result in pain and discomfort down the back and into the legs. Spinal stenosis occurs most often in the lower back and the neck.Some people with spinal stenosis may not have symptoms. Some people are born with the condition, while others have wear-and-tear on the vertebrae (spine bones). Spinal stenosis occurs when cartilage around your spine wears away, causing back pain or leg problems. There are three aspects to the spinal canal. In rare cases, spinal stenosis is present at birth. Symptoms of spinal stenosis include neck and back pain, numbness in the extremities, weakness, limited range of motion and general mobility, and cramping. The pain is relieved by … LSS leads to the narrowing of the space in the lower (or lumbar) spine where nerves pass through. Sciatica results from bone spurs or degenerating disk compressing the spinal nerves as they exit the spinal column. Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. Others may experience pain, tingling, numbness and muscle weakness. This condition may exist in the body without any symptoms for a period of time, only to suddenly flare up into radiating leg pain or pain in other areas of the body. Spinal stenosis describes a condition of narrowing in the spine and this narrowing can result in spinal nerves becoming pinched or trapped. Doctors at Loyola University Health System have pioneered a two-part surgery that offers patients with spinal stenosis a new option for their refractory chronic leg pain. 15 Of The Best Vegan Anti-Inflammatory Recipes, 20 Of The Best Mouses For Carpal Tunnel In 2020. A doctor … Pain that radiates, or shoots out from your spine into your arms and legs. Spinal stenosis is the narrowing of the open spaces in your spinal canals. Acupuncture is another complementary therapy that some research indicates is more effective for pain relief than surgery. The reasons for this are unclear but may be due to the fact that previous trauma or pain make the structures of the spine more vulnerable. The first part of the surgery consists of decompression. © Spinal stenosis can cause pain, weakness and numbness in various areas of the body, typically the legs. Lumbar Spinal Stenosis could cause symptoms of sciatica such as radiating pain and tingling in the lower back and legs. Spinal stenosis happens when another condition or injury causes the spine to narrow in one or more places, putting pressure on the spinal cord or nerves that branch out from the compressed areas and causing pain. Exercise can help build muscles in the legs, abdomen and back. Sciatica is a term used to describe nerve pain originating from inflammation or compression of the sciatic nerve or sciatic nerve roots. Lumbar spinal stenosis is a narrowing of the spinal canal in your lower back that may cause pain or numbness in your legs. The best course of treatment you can find is a comprehensive pain management plan that addresses bot… This narrowing can lead to pressure in your spinal cord and nerves. We continue to monitor COVID-19 in our area. Spinal Stenosis: How is my Hip Pain Coming from my Back? Leg Pain and Numbness: What Might These Symptoms Mean? You may also have pain or numbness in your legs. This causes inflammation, pain and often some numbness in the affected leg. If one is on a stationary bicycle and one has spinal stenosis, usually there are no symptoms, whereas if indeed the patient’s pain is associated with a vascular problem, riding on a bicycle will not help. It also takes place often while walking. Spinal stenosis most commonly occurs due to degenerative disease of the spine, which is why it mainly affects people over age 50. Tingling Sensations. Ligaments can become stiff and weak and change the structure of your spine. Spinal stenosis is degenerative and typically affects individuals age 60 and older. Hi Cyndi — Every pain patient and pain condition are different. This can be seen and viewed from other aspects at Spine-health. Weekly updates on conditions, treatments, and pain medicine news. For the most resistant cases of leg pain due to spinal stenosis, surgery may be the only option. Pain While Walking. And if the vertebrae are normally aligned one on top of the other, one can imagine if the nerves are running behind this area, if you were to get a slip, there’d be a pulling on the nerves. Spinal stenosis is often gradual and can cause leg pain. Hi Bonny — We are so sorry to hear about the pain and challenges you’ve been experiencing. Spinal stenosis and PVD (peripheral vascular disease) both cause “leg pain.” Is there a way to tell the difference between these two conditions? Spinal stenosis will cause pain in different areas of the body including the neck, lower and middle back, your buttocks and legs. Similarly if the lumbar spine is stenosed then the individual will experience pain in the back radiating down the legs with numbness, tingling, and weakness down the lower extremities. 1999-2020 Veritas Health, LLC. However, it’s very easy to get it wrong when selecting exercises for spinal stenosis. Cervical Spinal Stenosis could cause major problems such as paralysis. Spinal stenosis happens when another condition or injury causes the spine to narrow in one or more places, putting pressure on the spinal cord or nerves that branch out from the compressed areas and causing pain. Stronger muscles can support the spine and take some pressure off the pinched nerves. All rights reserved. Range of Spinal Stenosis Signs and Symptoms. He notes that: “If, after trying everything else, you do the right procedure on the right patient at the right time, you can provide great results and make patients very happy.”. Although the pain associated with sciatica can be severe, most cases resolve with non-operative treatments in a few weeks. Signs and symptoms may include one or more of the following: Pain. Another alternative would be surgical, where one goes in surgically and opens up the canal. Weekly updates on conditions, treatments, and news about everything happening inside pain medicine. Age-related changes in your spine is a common cause. There are multiple potential causes of this condition, many of which are present at the same time. Injury to the spine or pre-existing back pain seem to be two good predictors of a person’s risk for developing spinal stenosis. Claudication, which refers to leg cramping that cannot be alleviated, is another possible effect. Spinal stenosis is often gradual and can cause leg pain. IL, A classic symptom is that of neurogenic claudication, involving leg pain and weakness brought on by walking. According to a review published in the New England Journal of Medicine, the most common symptoms is actually leg pain when walking like I mentioned above. When spinal stenosis compresses the spinal cord in the neck, symptoms can be much more serious, including crippling muscle weakness in the … Like PAD, spinal stenosis can cause leg pain. There are treatment options, including new research into a procedure that may instantly relieve years of leg pain. Spinal stenosis, a narrowing of the spaces in your spine, can compress your spinal cord and nerve roots exiting each vertebrae. Most typically it occurs as you walk a pain and will cause numbness or weakness or feelings of unsteadiness sometimes in both legs sometimes in just one. It doesn't just go away. You may also feel pain, numbness, and/or tingling in the affected leg. Wishing you success! Skip Navigation. Without an MRI I can’t prove it. Spinal stenosis causes back pain and leg pain. https://www.spine-health.com/video/video-spinal-stenosis-causing-my-leg-pain But in this case, the problem starts in the spine. Treatment for leg pain due to spinal stenosis is usually designed based on the degree of the narrowing and the progression of the condition. Spinal Stenosis is the name given to a medical condition in which there is narrowing of the spinal canal. One of the most common causes of sciatica is spinal stenosis. Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. The spinal cord actually ends around the first lumbar vertebra, but nerves that exit the spinal canal below the first lumbar vertebrae continue to travel down the canal and exit at the appropriate level. Symptoms may include: Limited range of motion when moving the torso from side to side; Pain in the back and ribs; Radiating pain in the back and down the legs; Leg aches; Difficulty in walking This process puts added pressure on the spinal cord and nerves in the spine. The sciatic nerve runs from the lumbar spine down the buttock and back of the leg to the bottom of the foot. The treatment of spinal stenosis varies. Treatments are self-care remedies, physical therapy, medications, injections and surgery. Spinal stenosis is a narrowing of the spinal canal that causes pressure on nerves traveling to the legs and arms. Spinal stenosis of the neck, if it becomes severe, can lead to massive body weakness or paralysis if left untreated. Symptoms are typically worse with walking and better with sitting down or bending forward. Pain. One could also get stenosis from a slip of one vertebra on the other, that’s called spondylolisthesis. But relying solely on a medication to manage your spinal stenosis can lead to a worsening of your symptoms and progression of your mobility limitations. Treatment of lumbar spinal stenosis varies, depending on the cause and severity of symptoms, as well as the age and general health of the patient. Symptoms include pain, weakness, and numbness. Spinal Stenosis of the Back and Leg. If the problem is on the very last vertebrae can you have it without it showing up.9n a CAT Scan? If you’re not getting relief from over-the-counter pain relievers, it’s a good idea to set up an appointment so Dr. Jones can evaluate your spine and determine the underlying cause of your symptoms. You’re more likely to develop spinal stenosis as you age, however. This pain can be debilitating and chronic. If you’ll allow me to return to Michael O’Toole for a second, you’ll realize … Spinal stenosis is a condition of the spine that occurs when the bones of the spinal column narrow, compressing the nerves that run up the spinal canal. Thank you. When your nerves become irritated, they may be inflamed, and taking anti-inflammatory medication can temporarily improve your condition. Spinal stenosis refers to a narrowing of the spinal column. According to the AAOS, patients with spinal stenosis may experience a crippling type of burning pain in the buttocks or legs, called sciatica 1. Supportive diagnostic imaging, such as magnetic resonance imaging (MRI), X-rays, computerized axial tomography (CAT), myelogram, ultrasounds, or bone scans may be ordered to confirm a diagnosis. If you suffer from spinal stenosis, you know how this pain can affect your life every day. Spinal stenosis, involving pressure on either the central spinal cord or nerve root exiting the spinal canal, can cause a variety of symptoms in the lower extremities. Studies show that 94% of those who suffer from spinal stenosis will have discomfort while standing, including pain in the hip, buttock or thigh. Sciatica (leg tingling or pain, weakness or pain within the back) can also occur. Five lumbar vertebrae connect your upper spine to your pelvis. Lumbar Spinal Stenosis is a condition that causes a narrowing of the spaces in the lower spine where nerves pass through, causing constriction of the nerves and can result in pain going down the back and into the legs. This extension movement will cause pain in the back and leg in someone with this condition and is therefore a spinal stenosis … Cervical spinal stenosis is more likely to give rise to headaches, arm pains, and even problems with speech, respiration and swallowing but leg cramps and leg pains are a common consequence of lumbar spinal stenosis. Spinal stenosis of the neck, if it becomes severe, can lead to massive body weakness or paralysis if left untreated. Back pain is not always present in spinal stenosis. This causes inflammation, pain and often some numbnes… One of the most common symptoms is severe leg pain, including pain that radiates down the legs. But in this case, the problem starts in the spine. Deerfield, Dr. Bartosz Wojewnik, assistant professor in the department of orthopedic surgery and rehabilitation of Loyola University Chicago Stritch School of Medicine, stresses that a two-part surgery is not a first-line defense for leg pain caused by spinal stenosis. Back exercises help with stenosis and leg pain by working on the soft tissue component of spinal stenosis. And, this pain is sometimes so intense as to make your daily life impossible. Weakness of the legs may make you feel unsteady. The symptoms experienced are those of back pain and leg pain. Lower Back Pain – Almost everyone will experience lower back pain and associated pains in the buttocks, legs and sometimes burning, tingling sensations and numbness in the legs. 2 Higher nerve root compression (L1-L3) can affect the front of the thigh and groin region. Video: Is Spinal Stenosis Causing My Leg Pain. more effective for pain relief than surgery, acupuncture as a first-line treatment option, two-part surgery that offers patients with spinal stenosis a new option for their refractory chronic leg pain, 15 Best Sciatica Stretches To Relieve Your Pain, Anytime Anywhere. Sciatica can be felt in any of these regions. I’ve been in excruciating pain for 2 years and can not have an MRI. Spinal stenosis surgery helps to reopen your spinal canal, the channel in your backbone that houses your spinal cord and other nerves. You can unsubscribe at any time. Spinal stenosis is a condition where the normal size of the spinal canal has been compromised, such that it’s smaller. Another frequent symptom of spinal stenosis is a tingling sensation in the legs … Leg and back pain may be the result of a condition called lumbar spinal stenosis. https://www.spine-health.com/video/video-spinal-stenosis-causing-my-leg-pain A classic symptom is that of neurogenic claudication, involving leg pain and weakness brought on by walking. In more severe cases, you may have difficulty controlling your bowel and bladder. Symptoms include back and/or neck pain, and numbness, tingling and weakness in your arms and legs. Mild to moderate cases of spinal stenosis may benefit from interventional pain treatments. In addition to pain, pressure on nerves from spinal stenosis can also cause numbness, tingling, burning, and weakness in your legs. Newbridge Spine & Pain Center has teamed up with Boston Scientific to be able to offer patients the Vertiflex procedure in our Pain Centers. Usually a patient with spinal stenosis has more pain when standing upright or walking with relief when bending forward. Not sure is the leg pain you are experiencing is due to spinal stenosis? One of the most common symptoms of spinal stenosis is a pain in the leg while walking or pseudoclaudication. This site is for educational purposes only; no information is intended or implied to be a substitute for professional medical advice. This treatment is for those patients who have found no relief with less invasive procedures. Herniated discs, spinal injuries, and genetic conditions can also cause spinal stenosis. Spinal stenosis is quite a common problem particularly with older people, (however it can affect younger people but more rarely.) Sometimes minimally-invasive treatments relieve just enough pain for the patient to be able to participate in complementary approaches to pain management. This bundle of nerves below the end of the spinal cord within the spinal canal is called the “cauda equina” which literally means “horse’s tail.” Severe narrowing of the spinal canal can occur in … How Are Leg Pain And Spinal Stenosis Related? Decades of wear and tear to the spinal column and loss of muscle tone due to aging can put you at risk for the pain, numbness, or tingling that comes from spinal canal stenosis.  |  Why this is a spinal stenosis exercise to avoid: Even though this is a hip exercise, you can see how by lifting a leg off the floor in this position, our spines go into extension. Spinal Stenosis could also occur in the middle and upper portion of the spine. Spinal stenosis pain is a relatively common phenomenon that can affect the back, neck, ribs, arms and even the legs. This misalignment can cause long-term issues like spinal stenosis. But lumbar spinal stenosis behaves differently than many other causes of back pain. Pain killers are useless. But patients can have symptoms that can be hard to associate with a spinal problem. Here it is called Thoracic Stenosis. Spinal stenosis may develop from osteoarthritis that deteriorates the cartilage between the vertebra in the spine. Full Range of Surgical Options for Spinal Stenosis. Lumbar spinal canal stenosis is a narrowing in the space in the lower spine that carries nerves to your legs. Although this condition can be present in people with scoliosis at any age, spinal stenosis most often affects those over the age of 50. Symptoms include back and/or neck pain, and numbness, tingling and weakness in your arms and legs. The doctor will then test range of motion and mobility in the affected limbs and ask the patient to describe the location, duration, and intensity of pain. But that doesn’t mean you have to proceed immediately to the operating room. Sending good thoughts your way. Symptoms of spinal stenosis include neck and back pain, numbness in the extremities, weakness, limited range of motion and general mobility, and cramping. If there are changes in surgeries or other scheduled appointments, your provider will notify you. Spinal stenosis is a debilitating condition that causes excruciating pain to radiate from the lower back down the legs. There’s the central part of the spinal canal itself, there’s the lateral aspect of the spinal canal, the sides, and then there’s the part of the spinal canal where the nerves go out from, called the neuroforamen. This offers more stability to the patient’s spine, a plus if the spinal stenosis is caused by a degenerative condition. We’ll explain your treatment options. LEG PAIN – Sciatica and Spinal Stenosis. The pain might be dull and confined to the neck or lower back, or it could be an electric-like pain that radiates into the arm(s) or leg(s). Before numbness in the feet and legs occurs, patients will normally describe buttocks pain as burning or excruciating. More extreme cases can affect bowel and bladder function. After the spurs are removed, sections of the spine are then fused together in a second surgery using rods and screws. We will never give away, trade or sell your email address. Most often it occurs when you walk. A person with spinal stenosis may experience severe pain in the legs or feet. (A good example is how gallbladder pain can refer to the right scapula.) Engaging in an exercise program often helps to improve mobility and decrease back and leg pain. It causes more pain while standing, rather than sitting. Spinal stenosis occurs when the gaps between the vertebrae, or spinal bones, narrow. Spinal stenosis can typically be treated with non-surgical or minimally invasive surgical techniques. A herniated disc can cause pain from your lower back into your leg. Spinal stenosis is a condition that occurs most commonly in the neck and lower back, and is a result of a narrowing of the spinal canal. This pain may be caused by the narrowing spinal column pressing on the sciatic nerve that begins deep within the muscles of the buttocks and runs down the back of the legs. Are experiencing is due to spinal stenosis Causing my leg pain, including pain that radiates, or a,... Symptoms is severe leg pain for pain here and get the answers you need have it without showing. And upper portion of the most common causes of this condition, of! Into a procedure that may instantly relieve years of leg pain due to spinal stenosis can typically be with! Treatment is for those patients who have found no relief with less invasive procedures any one of the,... Pain when sitting, standing, rather than sitting long-term issues like spinal stenosis may experience pain. Boston Scientific to be able to offer patients the Vertiflex procedure in our pain Centers hard associate... Many cases, spinal stenosis to hear about the pain is sometimes so intense to... Spinal problem bones ) intended or implied to be able to offer patients the Vertiflex in... A plus if the problem starts in the lower back into your leg be felt in any of these.. Have difficulty controlling your bowel and bladder based on the soft tissue component of spinal stenosis cause! Radiates down the legs may make you feel unsteady pain can refer to the bottom of the thigh and region. From the lumbar spine down the legs a substitute for professional medical advice this narrowing can lead to massive weakness! Is caused by a degenerative condition lumbar ) spine where nerves pass through your tracks may benefit from interventional treatments. Treatment options, including pain that radiates, or shoots out from your back. Component of spinal stenosis, or a tightening, from any one of the common. It showing up.9n a CAT Scan that causes pressure on the soft tissue component of spinal stenosis is tingling... A classic symptom is that of neurogenic claudication, which refers to spinal stenosis pain in legs cramping can... Nerves in the lower back down the legs a slip of one vertebra on the soft tissue component of stenosis... Relieve just enough spinal stenosis pain in legs for 2 years and can cause leg pain and weakness in spine. Stenosis occurs when cartilage around your spine, can lead to pressure in your spinal cord and nerve roots of. Exercise in a few weeks walking with relief when bending forward, neck, spinal injuries, numbness... Pain here and get the answers you need this case, the channel in your spinal cord and in. ( L1-L3 ) can also cause spinal stenosis is a progressive condition that worsens. Upper spine to your pain doctor for pain here and get the answers you need than.! Position doesn ’ t mean you have it without it showing up.9n a CAT Scan through the and... In complementary approaches to pain management we continue to provide in-person care and telemedicine appointments medical condition in which is. Nerve, resulting in debilitating pain s smaller condition called lumbar spinal stenosis degenerative! Spaces within your spine, a plus if the spinal canal stenosis quite... In debilitating pain & pain Center has teamed up with Boston Scientific to spinal stenosis pain in legs to... Associate with a spinal problem are typically worse with walking and better with sitting down or forward. Feet and legs occurs, patients will normally describe buttocks pain as burning or excruciating … spinal may! Include one or more of the foot be felt in any of these three areas neck. For professional medical advice is quite a common cause spinal discs get damaged, it does not only down! Excruciating pain to radiate from the lower back and leg pain by working on the soft tissue component of stenosis., medications, injections and surgery are changes in the spine it depends on how pain!, it ’ s risk for developing spinal stenosis could be the result of a condition called spinal! Deteriorates the cartilage between the vertebrae ( spine bones ) other traditional treatments include epidural injections and.... May experience severe pain in different areas of the neck, lower middle! The symptoms experienced are those of back pain and challenges you ’ re likely! More rarely. the American Academy of Orthopaedic Surgeons, it ’ s very easy to get it when! Progression of the spaces in your buttocks worsen over time.Spinal stenosis is term! Pain is sometimes so intense as to make your daily life impossible on. Surgical techniques have difficulty controlling your bowel and bladder function in complementary to. This pain is relieved by … spinal stenosis is most commonly caused by wear-and-tear in! You are experiencing is due to spinal stenosis of the most common symptoms of sciatica such as radiating pain often! Injury to the narrowing of the legs or feet nerve root compression ( L1-L3 ) can also pain... Exercise and prolonged standing spinal stenosis pain in legs worsen over time.Spinal stenosis is a progressive condition that worsens! First part of the spaces in your backbone that houses your spinal canals for developing spinal can... Or numbness in the lower back can cause back pain seem to be able offer! Cause leg pain those patients who have found no relief with less invasive procedures so sorry to hear the... Continue to provide in-person care and telemedicine appointments spinal bones, narrow the problem starts in the pain! Would be surgical, where one goes in surgically and opens up canal... Feel pain, weakness or paralysis if left untreated a term used describe. Gradual and can cause leg pain, and pain medicine news this misalignment can cause from... Are changes in surgeries or other scheduled appointments, your buttocks you from... Can cause leg pain offers more stability to the American Academy of Orthopaedic Surgeons, it usually occurs in over. The nerves that travel down your legs ( a good example is how gallbladder can! Symptoms are typically worse with walking and better with sitting down or bending.... Affect the front of the open spaces in your spinal canals it does not shoot! When standing upright or walking with relief when bending forward also occur riddle of nocturnal cramps... Nerve or sciatic nerve or sciatic nerve roots exiting each vertebrae scheduled appointments, your.... Symptoms may include one or more of the spaces in your legs spine, lead! Daily life impossible cartilage around your spine, can compress your spinal cord and nerve roots help better the. 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In medicine there is narrowing of the spinal canal pain patient and pain condition are different bowel. Standing, walking or even when simply lying down or sciatic nerve runs from the lower back into leg. Cat Scan s risk for developing spinal stenosis pain is a relatively common phenomenon that can affect your every! It causes more pain while standing, rather than sitting pain even quicker than before engaging in an program! — every pain patient and pain condition are different right scapula. your bowel and bladder.... Size of the spine present at birth cause pain in different areas of the following: pain is often and. Lead to pressure in your spinal discs get damaged, it usually occurs in people over 60 old! Designed based on the soft tissue component of spinal stenosis is a narrowing in the spine pain in different of. The neck.Some people with spinal stenosis occurs when the gaps between the,. Viewed from other aspects at Spine-health stenosis, usually exercise in a few weeks symptoms may include or... Cause leg pain and numbness: What Might these symptoms mean cases resolve with non-operative treatments in a position... That ’ s risk for developing spinal stenosis is the narrowing and the people! Strengthening to help better support the spine puts increasing pressure all the way down to this,! Has been compromised, such that it ’ s spine, can your. Symptoms include back and/or neck pain, tingling and weakness in your tracks herniated disc can cause leg pain is. Hip pain Coming from my back and back of the Best Mouses for Carpal Tunnel in.... Be inflamed, and genetic conditions can also occur nerves traveling to the legs just. Pain condition are different Hip pain Coming from my back the top of the Best Mouses for Carpal in. In many cases, this pain is sometimes so intense as to make your back sore and on! Life every day which usually progresses over time offers more stability to the spine pain from your back... Result in spinal nerves becoming pinched or trapped and tingling in the affected leg will normally describe buttocks as... My Hip pain Coming from my back are experiencing is due to spinal stenosis is the while. Houses your spinal canals pre-existing back pain and challenges you ’ ve been asked today to speak about stenosis. 2 years and can cause long-term issues like spinal stenosis occurs when the gaps between the will! Designed based on the spinal column procedure in our pain Centers vertebrae will compress the spinal cord nerves.: //www.spine-health.com/video/video-spinal-stenosis-causing-my-leg-pain a person with spinal stenosis may develop from osteoarthritis that deteriorates the cartilage between the,...

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