What is Spinal Stenosis?
Spinal stenosis is the narrowing of the spinal canal or the spaces through which nerves pass (foramina). This narrowing compresses the spinal cord or nerve roots, causing pain, numbness, and weakness. It is most common in the lumbar spine (causing neurogenic claudication) and cervical spine (causing myelopathy).
Lumbar spinal stenosis affects approximately 10% of adults over 60 and is the most common reason for spine surgery in people over 65. The hallmark symptom is neurogenic claudication — leg pain and weakness with walking that relieves with sitting or bending forward.
Hallmark Symptoms — Neurogenic Claudication
Leg pain, heaviness, or weakness after walking a short distance
Relief when sitting down or bending forward (shopping trolley sign)
Lower back pain with or without leg radiation
Numbness and tingling in both legs
Difficulty standing for prolonged periods
Better walking uphill (flexed spine) than downhill (extended spine)
Causes
- Degenerative spondylosis — most common cause
- Hypertrophied ligamentum flavum — thickened ligament
- Facet joint osteoarthritis with osteophyte formation
- Disc herniation or bulge
- Spondylolisthesis — vertebral slippage
- Congenital narrow canal — developmental stenosis
Diagnosis
- MRI lumbar/cervical spine — best assessment of soft tissue and cord/nerve compression
- CT scan — detailed bone measurement of canal dimensions
- Vascular studies — to differentiate from vascular claudication
- X-ray dynamic (flexion/extension) — assess instability
Treatment Options
FAQs
Can spinal stenosis be treated without surgery?
Yes, many patients with mild to moderate stenosis manage well with conservative treatment including physiotherapy, epidural injections, and activity modification. Surgery is recommended when: symptoms significantly impair quality of life despite conservative treatment, walking distance is severely reduced, or there is progressive neurological weakness. Most patients experience excellent relief after decompression surgery.