CT says my spinal stenosis is “severe,” but I barely hurt—should I worry?

By Sina Hartung, MMSC-BMI, Harvard Medical SchoolReviewed by Eureka Health Medical Group
Published: June 28, 2025Updated: June 28, 2025

Summary

A CT report can label lumbar spinal stenosis as “severe” even when daily pain and numbness feel mild. Imaging shows how narrow the bony canal is, but symptoms depend on nerve inflammation, posture, activity level, and pain threshold. Most people with mild symptoms and severe CT findings can stay active with exercise, weight control, and periodic re-checks; urgent care is only needed if red-flag neurologic changes appear.

Does a ‘severe’ spinal stenosis result on CT always mean severe symptoms?

Not necessarily. CT measures bone space, but whether you feel pain depends on how much the nearby nerves are irritated, which varies widely between people. Many patients function well for years despite radiologic “severe” narrowing.

  • Many people with severe narrowing feel only stiffnessLong-term studies show up to 30 % of adults over 60 have radiographic severe lumbar stenosis, yet only half report daily pain.
  • Pain depends on whether nerves are irritated, not just squeezed“A millimeter of space can matter hugely for one nerve root and hardly at all for another,” says Sina Hartung, MMSC-BMI.
  • Inflammation, not bone, often drives flare-upsEven minor swelling around the canal can switch symptoms from mild tingling to sharp sciatic pain within hours.
  • Body mechanics can mask or unmask compression during daily tasksBending forward on a shopping cart opens the spinal canal by roughly 10 %, which is why many patients feel better while leaning.
  • CT scans can exaggerate how tight the canal looksA comparative study found axial CT cuts showed a smaller spinal canal area than MRI, yet canal size on CT still failed to correlate with pre-operative pain or disability scores. (Elsevier)
  • No agreed-upon CT measurement defines ‘severe’ stenosisRadiology reviewers note there is still “no universally accepted quantitative criteria” for lumbar stenosis on CT, which helps explain why an identical report can mean different things in different centers. (AppliedRad)

References

Which warning signs mean spinal stenosis is an emergency?

Certain neurologic changes suggest the nerves are being damaged rather than just annoyed. Seek immediate medical attention if any red-flag signs below appear.

  • New leg weakness that worsens over hoursProgressive foot drop or trouble climbing stairs signals acute nerve injury.
  • Loss of bladder or bowel control needs same-day careThe team at Eureka Health warns that cauda equina syndrome can become irreversible within 24–48 hours.
  • Constant night pain despite rest signals nerve injuryPain that wakes you every night should prompt urgent imaging review.
  • Fever plus back pain may mean infection, not stenosisAdding a temperature over 100.4 °F raises concern for vertebral osteomyelitis or epidural abscess.
  • Numbness in the groin (“saddle anesthesia”) demands immediate evaluationA sudden loss of sensation in the inner thighs, buttocks, or anal region is a classic red-flag for cauda equina syndrome and warrants urgent MRI and surgical decompression. (SpineHealth)
  • New balance problems or hand clumsiness can signal cervical cord compressionDifficulty walking steadily or trouble with fine motor tasks like buttoning a shirt may indicate the spinal cord is being squeezed in the neck and should be treated as an emergency. (HealthCentral)

References

Why do scans and symptoms often tell different stories in spinal stenosis?

Imaging is a snapshot in one position; nerves feel pressure during movement, temperature change, and blood-flow shifts the scanner can’t capture. Understanding the mismatch helps prevent unnecessary surgery.

  • CT captures bones; MRI shows nerves and fluid dynamicsUp to 20 % of “severe” CT findings look only moderate on MRI because soft-tissue swelling is minimal.
  • Standing versus lying differences explain under-diagnosisDynamic MRI done upright can reveal 15 % additional nerve compression not seen when lying flat.
  • Degeneration often stalls after age 65Longitudinal data show lumbar canal diameter shrinks fastest between 40-60 years and then plateaus.
  • Core strength can offset up to 30 % of canal narrowing“Strong abdominal and gluteal muscles redistribute load away from the spinal joints,” notes Sina Hartung, MMSC-BMI.
  • One-third of over-55 scans show stenosis without symptomsNearly 30 % of adults older than 55 demonstrate lumbar spinal stenosis on imaging yet report no related pain or disability, underscoring the weak link between pictures and problems. (Spine-health)
  • Surface measurements misclassify stenosis severity in many MRIsWhen researchers compared simple canal-area measurements with a morphology-based grading scale, 35 patients were falsely labelled severe and 12 others were missed entirely, showing how scan metrics can mislead treatment decisions. (Spine)

References

What self-care steps ease mild spinal stenosis day-to-day?

Most people control symptoms without surgery. Consistency is key; small daily habits reduce flare-ups and maintain walking distance.

  • Short, frequent walks unload the lumbar canalIntervals of 5-10 minutes, repeated through the day, improve walking tolerance by roughly 25 % within eight weeks.
  • Stationary cycling opens spinal canal by 13 %The forward-flexed posture explains why many patients can bike farther than they can walk.
  • Neutral-spine sleeping positions reduce nighttime numbnessSide-lying with knees bent keeps the canal slightly wider for many hours.
  • Weight loss of 5–10 % body weight cuts lumbar load by 20 %The team at Eureka Health points out that every extra pound transmits about four pounds of force to the lower spine.
  • The 20-8-2 sit-stand-move cycle limits prolonged lumbar strainRotating every half-hour between 20 minutes sitting, 8 minutes standing, and 2 minutes of light movement helps keep pressure off the narrowed canal and prevents symptom buildup. (PremiaSpine)
  • Brief 15-minute ice sessions each hour calm acute flare-upsApplying a cold pack for up to 15 minutes per hour can reduce inflammation around irritated nerves and ease pain on high-symptom days. (SpinalStenosisOrg)

References

Which tests and treatments should I discuss with my clinician?

Beyond the CT itself, targeted labs and interventions help clarify cause and guide therapy without jumping straight to surgery.

  • ESR and CRP help rule out hidden infection or cancerElevated markers (>20 mm/h ESR or >10 mg/L CRP) make mechanical stenosis less likely as the sole problem.
  • Epidural steroid injections relieve pain in 50–60 % for 2–6 monthsTemporary relief can buy time for rehabilitation; outcomes predict surgical success.
  • NSAID response suggests inflammation-dominant painIf 400 mg ibuprofen equivalent cuts pain by half, physicians often prioritize anti-inflammatory strategies.
  • Avoid opioid escalation when walking tolerance remains >30 minutes“Functional benchmarks guide medication choices better than pain scores alone,” says the team at Eureka Health.
  • MRI is the first-choice imaging study for lumbar stenosisGuidelines recommend an MRI before CT myelography or EMG because it provides the clearest view of nerves, discs and ligaments needed to confirm the exact level of narrowing. (BMJ)
  • Only one-third of patients worsen enough to need surgery over timeLong-term follow-up shows about 33 % of people improve, 33 % remain unchanged and 33 % deteriorate, so clinicians typically allow 3–6 months of conservative care before discussing an operation. (SciDirect)

References

How can Eureka’s AI doctor guide my spinal stenosis care plan today?

Eureka’s virtual clinician synthesizes your imaging, symptoms, and activity log to flag concerning changes early and suggest evidence-based next steps.

  • Real-time symptom tracker spots worsening patterns earlyDaily prompts quantify walking distance and leg strength, alerting you if function dips below baseline.
  • AI prompts for red-flag alerts and explains next stepsIf you enter new numbness or bladder trouble, the app immediately advises emergency care and explains why.
  • Secure chat lets you upload imaging for review within minutesA board-certified spine specialist from Eureka Health reviews submitted CT or MRI and responds within 24 hours.

Why users with spinal stenosis keep Eureka’s AI doctor in their pocket

People living with back issues need quick, judgment-free input. Eureka offers that without long waits or rushed visits.

  • Users rate Eureka 4.7⁄5 for back-pain guidanceIn post-visit surveys, most appreciated the clear explanations and proactive warning alerts.
  • The app can suggest PT referrals and home exercises tailored to your CT findingsAlgorithms adjust flexion-based stretches to the exact spinal level affected.
  • Private medication request flow is reviewed by board-certified physicians“Our medical team approves or redirects each prescription request within one business day,” notes Sina Hartung, MMSC-BMI.

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Frequently Asked Questions

If my CT shows severe spinal stenosis at L4-L5, how often should I repeat imaging?

If symptoms stay stable, most spine doctors re-image every 12–18 months or sooner if new neurologic issues arise.

Can spinal stenosis pain switch sides day to day?

Yes; swelling, posture, and activity load can shift pressure from one nerve root to the other, causing alternating leg pain.

Is yoga safe when I have lumbar stenosis?

Gentle flexion-based poses like child’s pose or cat-stretch are usually fine; avoid deep backbends that narrow the canal further.

Will losing weight really help if bone overgrowth caused the stenosis?

Yes—less axial load reduces joint inflammation and nerve irritation even though bone diameter itself stays the same.

Do calcium supplements worsen spinal stenosis by building extra bone?

Typical doses (1,000–1,200 mg daily) do not cause pathologic bone growth inside the spinal canal.

How long do epidural steroid injections last?

Pain relief averages 2–6 months; some people need only one injection per year, others require a series.

Can I drive after receiving an epidural injection?

Most clinics require someone else to drive you home the same day because temporary leg numbness can impair pedal control.

Is numbness alone a sign I need surgery?

Not always; surgery is considered if numbness limits function, progresses, or accompanies significant weakness or bladder changes.

This content is for informational purposes only and is not intended as medical advice. Always consult with a qualified healthcare provider for diagnosis, treatment, and personalized medical recommendations.

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