Patients who experience unexplained pain, stiffness, numbness or weakness in the back, legs, neck or shoulders should seek medical care. Spinal stenosis is especially likely when a patient has leg pain that worsens during walking but improves when sitting or bending forward.

Sudden inability to control bladder or bowel movements (incontinence) is a sign of cauda equina syndrome, a serious but rare form of spinal stenosis in which there is compression of the sack of nerve roots below the spinal cord. This condition demands immediate medical attention to prevent neurological damage.

In diagnosing spinal stenosis, a physician will review a medical history and perform a physical examination. Spinal stenosis is sometimes difficult to diagnose, as symptoms may come and go. In addition, symptoms associated with spinal stenosis can sometimes be mistaken for those of routine aging. The patient may be asked to complete a pain assessment.

Spinal stenosis is sometimes difficult to diagnose, as symptoms may come and go. In addition, symptoms associated with spinal stenosis can sometimes be mistaken for those of routine aging. A physician may therefore use various imaging tests to identify the source of symptoms. These tests include:

• X-ray. Though this test is unlikely to reveal spinal stenosis, it can help rule out other conditions that cause similar symptoms, including fractures, bone tumors or inherited defects.
  
  
• MRI (magnetic resonance imaging). The cross-sectional images revealed by this test can highlight damage to intervertebral discs and ligaments, and uncover the presence of tumors.

• CAT scan (computed axial tomography). Producing cross-sectional x-ray images, CAT scans may be used to reveal the shape and size of the spinal canal. However, this test exposes patients to more radiation than an x-ray and is not recommended for women who are pregnant.
  
  
• Myelography. Perhaps the most sensitive test for detecting spinal stenosis, it involves injecting a contrast dye into the spinal column that circulates around the spinal cord and spinal nerves. Myelograms can reveal herniated discs, bone spurs and tumors. However, because the test requires an injection into the spinal column, it poses slightly higher risks than some other procedures.
  
  
• Bone scan. A small amount of radioactive material is injected into a vein in the arm. The material attaches to bone and emits waves of radiation that are detected by a gamma camera. This type of radionuclide imaging can detect many bone disorders but usually cannot specify the type of disorder. For this reason, other tests are usually performed with bone scans to help diagnose bone conditions.

In some cases, a physician may inject a patient with a spinal nerve block or epidural corticosteroids. The patient is monitored for improvement in symptoms.