Spinal Stenosis (Narrowing of the Spinal Canal)
Spinal stenosis is a narrowing of the canal through which the spinal cord and nerve roots pass. It is most commonly seen in the lower back and is generally the result of wear that develops with age. Its typical picture is this: symptoms in the legs that increase on walking and ease on sitting or bending forwards.
Why Does the Canal Narrow?
The structures surrounding the spinal canal change over time: the discs lose height and protrude, the facet joints enlarge, and the ligament along the back wall of the canal (ligamentum flavum) thickens. The sum of these changes narrows the canal and the openings where the nerve roots exit.
Because the narrowing usually develops slowly, symptoms also begin insidiously. In some patients slippage of a vertebra (spondylolisthesis) accompanies the picture, and this can change the treatment plan.
The Typical Symptom: Neurogenic Claudication
The distinguishing feature of spinal stenosis is leg symptoms that increase with walking distance. The patient has to stop after a certain distance and obtains relief within a few minutes on bending forwards or sitting down. This is because bending forwards widens the canal a little.
- Heaviness, burning, numbness and a sense of weakness in the legs
- Relief when pushing a shopping trolley or riding a bicycle (a forward-leaning posture)
- Walking uphill being easier than walking downhill
- Symptoms increased by standing for long periods
- Back pain often being less prominent than the leg symptoms
This picture can be confused with symptoms due to arterial disease (vascular claudication). An important clue in distinguishing them is this: with a vascular cause stopping is enough, whereas in spinal stenosis it is usually necessary to sit down or bend forwards. Pulse examination and, where needed, vascular studies clarify the distinction.
Diagnosis
- History: walking distance, the posture that relieves symptoms, numbness and weakness, bladder and bowel symptoms.
- Neurological examination: muscle strength, reflexes, sensation and assessment of gait.
- Standing X-ray: for alignment, vertebral slippage and movement views.
- MRI: the principal method showing the site and degree of narrowing.
- Vascular assessment: requested where the picture could be due to arterial disease.
Treatment
Non-surgical treatment
Where symptoms do not seriously restrict daily life and there are no progressive neurological findings, the first approach is not surgical. The aim is to increase walking distance and bring pain to a manageable level.
- An exercise programme strengthening the trunk and hip muscles, weighted towards forward-flexion work
- A staged walking plan that increases distance gradually, with breaks
- Cycling and pool-based work — generally better tolerated thanks to the forward-leaning position
- Weight control
- Pain management; epidural injection treatments in selected cases
Injections can reduce symptoms in some patients and make it easier to start an exercise programme; the effect varies from person to person and is not presented as a permanent solution.
Surgical treatment
Surgery is considered where walking distance has shortened markedly despite an adequate period of non-surgical treatment, where daily life is seriously restricted, or where there is progressive neurological loss.
- Decompression: removing the structures causing the narrowing to relieve the nerves.
- Decompression with fusion: may be considered where vertebral slippage, instability or an alignment problem is present.
Age alone does not determine the decision; accompanying conditions, bone quality, alignment and the patient’s expectations are assessed together. Relief of leg symptoms is generally more predictable than relief of back pain, and this expectation is discussed openly before surgery. No guarantee of a specific result or timeframe is given for any treatment.
Daily Life Suggestions
- Break your walking into stages rather than doing it all at once; increase the distance over weeks
- If you have to stand for long periods, rest one foot on a low step
- When lifting, bend your knees and keep the load close to your body
- Work the trunk and hip muscles regularly
- Weight control directly affects the severity of symptoms
When Should You Seek Assessment?
- If your walking distance is becoming progressively shorter
- If numbness or weakness has started in your legs
- If your symptoms ease on bending forwards and increase on standing upright
- If you have balance problems or frequent falls
- If symptoms are increasing despite exercise and pain management
When to Seek Medical Help Without Delay
- Loss of bladder or bowel control, or an inability to pass urine
- Numbness around the anus and inner thighs (cauda equina syndrome) — may require emergency surgery
- Weakness developing in both legs at once
- Rapidly progressing foot drop or marked muscle weakness
- Night pain together with fever, weight loss or a history of cancer
These findings require urgent assessment. Outside office hours, go to the nearest emergency department.
Frequently Asked Questions
Does spinal stenosis get worse?
Because it is due to wear, it can change over time; however, it does not progress at the same rate in everyone. In some people symptoms remain at the same level for years. Follow-up is therefore recommended and changes in walking distance are monitored.
Is walking harmful?
No; on the contrary, walking is part of the programme. What matters is walking with breaks rather than forcing it all at once, and increasing the distance gradually. Cycling and pool-based work are also generally well tolerated because of the forward-leaning position.
If I do not have surgery, will I become paralysed?
The usual course of spinal stenosis does not end in paralysis; symptoms mostly limit walking distance. However, findings of cauda equina syndrome or rapidly progressing weakness are an emergency and require assessment without delay.
Is an injection a permanent solution?
No. An injection can reduce symptoms in some patients and make it easier to start an exercise programme; how long the effect lasts varies from person to person. It is not presented as a permanent solution on its own.
Will my back pain go completely after surgery?
The primary aim of surgery is to relieve pressure on the nerves and reduce leg symptoms. The change in back pain is less predictable. Expectations are discussed in detail beforehand and outcomes vary from person to person.
I am older — can I still have surgery?
The decision is based not on age but on general health, accompanying conditions, bone quality and how much symptoms restrict daily life. For some patients a non-surgical programme may be more appropriate.
Academic Work
Assoc. Prof. Bertan Cengiz, MD has scientific work published in national and international peer-reviewed journals in the field of spinal surgery and degenerative spinal disease and related areas. The publication list and verifiable academic sources are available on the Publications page.
Related Pages
- Spinal Disorders and Scoliosis
- Lumbar Disc Herniation
- Cervical Disc Herniation (Neck Hernia)
- Osteoporotic Fractures
- The First 48 Hours of Back Pain: What to Do and What to Avoid
The information on this page is for general guidance and does not replace an in-person medical examination. Diagnosis and treatment require a physician’s clinical assessment. Outcomes of any treatment or surgical intervention may vary from person to person; no guarantee of a specific result or timeframe is given on this page.