What is spinal stenosis?
Spinal stenosis is a narrowing of the spaces inside the spine, which reduces the room available for the spinal cord and nerves. When those nerves are crowded, they can become irritated and produce pain, numbness, or weakness. It most often develops in the lower back (lumbar stenosis) and sometimes in the neck (cervical stenosis).
A common pattern with lumbar stenosis is neurogenic claudication - aching, heaviness, or cramping in the legs that comes on with standing or walking and eases when you sit or lean forward. That is because bending forward opens up space around the nerves, which is why many people feel more comfortable pushing a shopping trolley or leaning on a rail.
The reassuring part: many people manage spinal stenosis for years without surgery. Our role is to confirm what is narrowing the canal and guide you to the least invasive treatment that keeps you moving.
Symptoms to look for
Stenosis symptoms tend to build slowly and are closely linked to posture and activity:
- Leg pain or cramping when walking or standing that eases when you sit down or bend forward (neurogenic claudication).
- Heaviness, tiredness, or weakness in the legs, so you can walk less far than you used to.
- Numbness or tingling in the buttocks, legs, or feet.
- Lower back ache that is often less troubling than the leg symptoms.
- Better with flexion - many people notice relief when leaning on a trolley, cycling, or sitting.
Symptoms can affect one or both legs. A careful examination - not the scan alone - is what tells us how much the narrowing is actually affecting your nerves.
CAUTION
New loss of bladder or bowel control, numbness around the groin or inner thighs, or rapidly worsening weakness in both legs can signal serious nerve compression. Treat these as an emergency and seek immediate medical attention.
What causes spinal stenosis?
Most stenosis is the result of gradual wear as the spine ages. Discs lose height and bulge, the small facet joints enlarge with arthritis, and the ligaments inside the canal thicken - together these slowly reduce the space around the nerves. This is why it is most common after 50.
Other contributors include a canal that was naturally narrow from birth, a slipped vertebra (spondylolisthesis), previous injury, or thickened bone. Carrying extra weight, smoking, and a sedentary desk-based routine can add to the strain over time.
How we diagnose it
Diagnosis begins with your history - especially how far you can walk and what relieves the pain - and a focused neurological examination of strength, reflexes, and sensation. An MRI is usually the clearest way to see the narrowing and which nerves are affected; in some cases a CT scan or X-ray adds useful detail.
Just as important, we match the imaging to your symptoms. Some narrowing is common on scans as we age and does not always cause trouble, so we treat the person - not the picture. Your assessment is led by a US board-certified neurosurgeon.
Treatment - least invasive first
We follow a measured, surgery-last approach. For most people that means starting with non-surgical care and escalating only if the evidence calls for it.
- Non-surgical care (first line for most). Physiotherapy focused on posture and core strength, staying active within comfort, and anti-inflammatory medication can meaningfully improve walking distance and daily function.
- Targeted injections. If leg symptoms persist, an image-guided epidural steroid injection can calm nerve inflammation and provide a window of relief that supports rehabilitation.
- Minimally invasive surgery (when it is warranted). If leg pain and limited walking persist despite non-surgical care, or weakness is progressing, relieving the pressure on the nerves can restore mobility. Where suitable, we use endoscopic decompression - a small camera through a tiny, muscle-sparing incision - to open up the space with minimal disruption to surrounding tissue.
- More extensive decompression (only if the condition demands it). For more advanced or widespread narrowing, an open decompression laminectomy remains a reliable, well-established way to give the nerves room. If the spine also needs stabilizing, your surgeon will discuss that with you honestly.
If you have already been told you need surgery, we are glad to give an honest second opinion on whether a less invasive path could work for you.
What to expect
Non-surgical care aims to improve how far and how comfortably you can walk rather than to reverse the narrowing itself, and progress is usually gradual over weeks. A steroid injection may give relief lasting weeks to months. If you do have decompression surgery, leg pain and walking often improve, many minimally invasive cases go home the same day or the next, and a guided return to activity follows over the following weeks. Your surgeon will explain the timeline for your specific case, and the plan is built around you.
Common questions
What is the main cause of spinal stenosis?
Most spinal stenosis is caused by gradual wear-and-tear changes in the spine as we age - thickened ligaments, bulging discs, and bone spurs from arthritis slowly narrow the space around the nerves. Less often it is present from birth or follows an injury. It is most common in people over 50.
Can spinal stenosis be treated without surgery?
Often, yes. Many people manage spinal stenosis for years with physiotherapy, activity adjustments, and anti-inflammatory medication, sometimes supported by an epidural steroid injection. Surgery is generally considered only when leg symptoms limit your walking and daily life despite non-surgical care, or when weakness is progressing.
What activities should be avoided with spinal stenosis?
Activities that arch the lower back and narrow the canal further - such as prolonged standing, walking downhill, or heavy overhead lifting - often worsen symptoms. Many people find that leaning forward, cycling, or walking while pushing a trolley is more comfortable, because bending forward opens up space around the nerves.
Does spinal stenosis get worse over time?
It can progress slowly because the underlying changes are age-related, but it varies widely and does not always get worse. Many people stay stable for years with the right care. Regular gentle activity and keeping to a healthy weight can help. A review lets us track your symptoms and adjust the plan as needed.
How successful is surgery for spinal stenosis?
Decompression surgery aims to relieve pressure on the nerves and commonly improves leg pain and walking distance, though results vary from person to person and depend on factors such as how long symptoms have been present. Back pain may improve less than leg pain. Your surgeon will explain the likely benefits and risks for your specific case.
What warning signs should I not ignore?
Seek urgent medical care if you develop new loss of bladder or bowel control, numbness around the groin or inner thighs, or rapidly worsening weakness or numbness in both legs. These can signal serious nerve compression that needs prompt assessment rather than watchful waiting.