Spinal canal stenosis refers to a narrowing of the spinal canal, which compresses the spinal cord and nerves.
It commonly occurs due to age-related degeneration, disc bulging, ligament thickening, or bone overgrowth (osteophytes).
The condition most often affects the lumbar (lower back) and cervical (neck) regions.
With modern microsurgical and minimally invasive decompression techniques, patients can achieve significant pain relief and functional recovery.
Symptoms
Lumbar Spinal Stenosis (Lower Back)
- Low back pain that increases with standing or walking and improves when bending forward (neurogenic claudication)
- Numbness, tingling, or weakness in the legs
- Cramping or heaviness after walking short distances
- Relief when sitting or leaning forward, known as the “shopping cart sign”
- In advanced cases: bladder or bowel control problems due to nerve compression
Cervical Spinal Stenosis (Neck)
- Neck pain radiating to shoulders or arms
- Numbness, tingling, or weakness in the hands or legs
- Unsteady gait or balance problems
- Fine motor difficulty, such as buttoning clothes (sign of cervical myelopathy)
- In severe cases: stiffness, spasticity, or urinary urgency due to spinal cord compression
Early diagnosis is crucial — untreated stenosis may lead to permanent nerve or spinal cord damage.
Diagnosis
Diagnosis begins with a neurological examination assessing muscle strength, sensation, and reflexes.
MRI of the spine is the gold standard, showing narrowing of the canal and nerve compression.
CT scan can identify bone spurs or thickened ligaments.
Dynamic X-rays (flexion–extension views) may be used to assess spinal instability.
In some cases, electromyography (EMG) helps confirm nerve involvement.
Treatment Options
1. Conservative (Non-Surgical) Management
- Physiotherapy and posture training to strengthen back and core muscles
- Anti-inflammatory medications and pain relief
- Epidural steroid injections to reduce nerve inflammation
- Activity modification and use of assistive devices if needed
Mild to moderate cases often improve with these measures.
2. Microsurgical Decompression (Laminectomy / Laminotomy)
When conservative therapy fails or neurological symptoms progress, microsurgical decompression is the standard treatment.
Through a small incision, thickened ligaments and bone overgrowth are removed under the microscope to relieve pressure on nerves.
Partial bone removal (laminotomy) preserves spinal stability while restoring canal space.
In multilevel stenosis, laminectomy may be combined with instrumented fusion if instability exists.
3. Minimally Invasive & Keyhole Techniques
For selected patients, minimally invasive or keyhole decompression can achieve the same results through a smaller incision and less muscle trauma, leading to faster recovery and less postoperative pain.
4. Spinal Stabilization (When Stenosis Is Secondary to Instability)
In some patients, spinal canal stenosis develops as a result of instability — often due to degenerative changes, previous surgery, spondylolisthesis, or facet joint degeneration.
In such cases, decompression alone may worsen the instability.
To maintain spinal alignment and prevent further slippage, stabilization with screws and rods (instrumented fusion) is performed together with decompression.
Modern minimally invasive fusion techniques allow strong fixation with smaller incisions and faster recovery while preserving motion at adjacent levels when possible.
Recovery & Follow-Up
Most patients stand and walk within a few hours after surgery.
Hospital stay is typically 1–3 days, depending on the number of levels treated.
Physiotherapy begins early to rebuild muscle strength and flexibility.
MRI or X-ray follow-up is performed periodically to ensure canal decompression and spinal stability.
Improvement in walking distance and reduction of leg or arm pain are usually noticeable within weeks.
When to See a Neurosurgeon
If you experience pain or numbness while walking, difficulty using your hands, or balance problems, consult a neurosurgeon.
Early surgical evaluation helps prevent irreversible spinal cord or nerve injury and restores mobility.