Spine conditions

Spinal stenosis is when the spinal canal (the tunnel down your spinal column containing your spinal cord and nerves) becomes too narrow. This narrowing can put pressure on the nerves and blood vessels that pass through the spine. This can lead to pain and other symptoms.

Spinal stenosis is often considered a degenerative condition since it usually develops as we age. However, younger people may experience it if they have spinal conditions such as scoliosis, congenital spinal abnormalities or a history of spinal injury.

This condition most commonly affects the lower back (lumbar stenosis) and the neck (cervical stenosis). While less common, it can also occur in the middle part of the spine (thoracic stenosis). The severity of symptoms can vary from person to person.

What are common symptoms?

The symptoms of spinal stenosis depend on which part of the spine is affected. Some people may not experience any symptoms, while others may have significant discomfort. Symptoms can include:

• Pain in the back or neck
• Pain, numbness, or tingling in the arms, hands, legs, or feet
• Muscle weakness
• Stiffness
• Problems with balance and coordination
• Difficulty walking for long distances
• Bowel or bladder dysfunction (in severe cases)

Symptoms often worsen over time and may become more noticeable during activities such as walking or standing for extended periods. Some people find relief when sitting or bending forward.

What causes spinal stenosis?

Spinal stenosis is usually caused by changes in the spine that occur with ageing, but it can also result from injury or congenital conditions. The most common causes include:

• Herniated discs – spinal discs act like cushions between each vertebra of the spine, but sometimes the soft insides herniate (leak out), putting pressure on the spinal cord or nerves.
• Bone spurs – these are bone growths on the spine that develop due to arthritis and can narrow the spinal canal.
• Thickened ligaments – the cords that help to hold the spine bones together can thicken over time, pressing on the spinal nerves.
• Spinal injuries – trauma to the spine can damage the spine and lead to stenosis.
• Tumours – although rare, tumours can grow inside the spinal canal, causing pressure on the nerves
• Congenital spinal conditions – some people are born with a narrower spinal canal or develop scoliosis (a curvature of the spine) that contributes to stenosis.

How is spinal stenosis diagnosed?

A neurosurgeon specialising in spinal conditions can diagnose spinal stenosis by assessing your medical history, performing a physical examination and ordering medical imaging. These may include:

• Magnetic resonance imaging (MRI) scans – provides detailed images of the spinal cord, discs, and nerves to detect any compression.
• Computed tomography (CT) scans – often used with a contrast dye (CT myelogram) to highlight areas of nerve compression.
• X-rays – show changes in the spine, such as bone spurs or narrowing of the spinal canal.

These tests help determine the cause and severity of the stenosis, guiding treatment decisions.

When should I see a doctor?

You should see a doctor if you experience:

• Persistent pain in your back, neck, arms or legs
• Numbness, tingling, or muscle weakness
• Difficulty walking or maintaining balance
• Problems with bowel or bladder control

If symptoms are mild, your doctor may recommend monitoring the condition. However, if symptoms are severe or worsening, early intervention by a neurosurgeon can help prevent complications.

How is spinal stenosis treated?

Treatment for spinal stenosis depends on the severity of symptoms. Options include:

Non-surgical treatments

• Physiotherapy – strengthening the muscles that support the spine can help reduce pain and improve mobility. A physiotherapist may recommend gentle exercises such as swimming or stretching.
• Pain relief medications – non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol or stronger medications such as opioids may be prescribed for pain management.
• Steroid injections – corticosteroid injections can reduce inflammation around the affected nerves, providing temporary relief.
• Lifestyle modifications – maintaining a healthy weight, using supportive footwear and modifying daily activities can help reduce strain on the spine.

Surgical treatments

If non-surgical treatments do not provide relief or if symptoms are severe, surgery may be recommended. Surgical options include:

• Laminectomy – removal of part of the vertebra (lamina) to create more space in the spinal canal.
• Discectomy or microdiscectomy – removal of part of a herniated disc to relieve pressure on the nerves.
• Spinal fusion – joining two or more vertebrae to stabilise the spine and prevent further narrowing.

A neurosurgeon will assess whether surgery is the best option based on individual circumstances, ensuring you receive the most appropriate spinal stenosis treatment plan.

How is spinal stenosis prevented?

While spinal stenosis cannot always be prevented, certain lifestyle choices may help reduce the risk of developing it or slow its progression:

• Maintain a healthy weight – excess weight puts additional stress on the spine.
• Stay physically active – regular exercise, including core strengthening and stretching, can help support the spine.
• Use proper posture – avoid slouching and practice good ergonomics when sitting and lifting objects.
• Manage arthritis and other conditions – early treatment of conditions such as osteoarthritis can help prevent excessive bone growth in the spine.
• Avoid smoking – smoking reduces blood flow to spinal tissues, which can contribute to degeneration.

By taking these steps, you can help protect your spine and maintain mobility as you age.

Sources

1. Weinstein JN, Tosteson TD, Lurie JD, Tosteson A, Blood E, Herkowitz H, et al. Surgical versus non-operative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial (SPORT). Spine 2010;35(14):1329.
2. Whitman JM, Flynn TW, Childs JD, Wainner RS, Gill HE, Ryder MG, et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine 2006;31(22):2541-9.
3. Djurasovic M, Glassman SD, Carreon LY, Dimar JR, Contemporary management of symptomatic lumbar spinal stenosis. Orthopedic Clinics 2010;41(2):183-91.
4. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Spinal stenosis: Diagnosis, Treatment, and Steps to Take.

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