Spinal Stenosis

What is this condition?

Spinal stenosis is narrowing around the spinal cord or nerve roots from enlarged joints, thickened ligaments, disc bulging, slippage or deformity. Lumbar stenosis often causes leg heaviness or pain while standing and walking; cervical stenosis can injure the spinal cord and affect hands, balance and bladder function.

What symptoms can it cause?

• Leg pain, numbness or heaviness on walking, relieved by sitting or bending
• Reduced walking distance and balance
• Cervical disease: clumsy hands, stiff legs, falls or fine-movement loss
• Severe disease may cause weakness or bladder/bowel change

How is it assessed and diagnosed?

Standing X-rays assess alignment and slippage; MRI shows the nerves and cord; CT helps with bone or previous implants. The clinical pattern must match the narrowed level. Vascular disease, hip/knee problems and peripheral neuropathy can mimic lumbar stenosis and should be considered.

Treatment without surgery

Activity modification, physiotherapy, appropriate analgesia and management of weight, diabetes and bone health are first-line for many lumbar cases. Injections can provide temporary relief in selected nerve-root pain. They do not reverse cord injury in cervical myelopathy.

When is surgery or a procedure considered?

Surgery is considered when walking and function remain severely limited, weakness progresses, cervical myelopathy is present or cauda equina symptoms emerge. Decompression removes the structures crowding nerves. Fusion is added when instability, deformity or the required decompression would make the spine unstable—not simply because stenosis exists.

Treatment and procedure options

• Laminectomy, laminotomy or targeted decompression
• Minimally invasive decompression in selected anatomy
• Decompression plus fusion for proven or expected instability
• Multilevel cervical anterior or posterior strategies based on alignment

Risks from the disease and from treatment

Untreated cord compression can leave permanent gait and hand dysfunction. Lumbar stenosis more often causes progressive disability than paralysis, but emergencies can occur. Surgery risks include dural tear, infection, nerve injury, instability, implant issues and incomplete relief of back pain. No procedure is risk-free. General risks include anaesthetic problems, bleeding, infection, blood clots and delayed healing. Neurological risks depend strongly on the exact structure being treated and may include new weakness, numbness, speech or vision change, seizure, cerebrospinal-fluid leakage, need for another procedure or failure to obtain the hoped-for relief. The surgeon should discuss the risks that apply to the individual case.

Recovery and follow-up

Walking commonly starts early, but endurance improves gradually. Nerve pain may improve faster than numbness. Patients with cervical myelopathy may stabilise rather than fully recover; preventing further decline can itself be a meaningful success. Recovery is not judged only by the first few days. Pain control, wound care, nutrition, safe mobilisation, physiotherapy and planned follow-up all matter. Some symptoms improve quickly after pressure is relieved; others recover gradually over weeks or months, and permanent nerve injury may not fully reverse.

Preparing for your consultation

Bring the original MRI/CT images or digital files, written reports, previous prescriptions, a current medicine list, and any operative or pathology records. For sudden warning symptoms, use the nearest emergency department rather than waiting for a routine appointment.

Authoritative patient-information sources

• AANS — Lumbar Spinal Stenosis: https://www.aans.org/patients/conditions-treatments/lumbar-spinal-stenosis/