Spinal Stenosis

Spinal stenosis refers to narrowing of the spinal canal or the passages through which nerve roots exit the spine. This narrowing can compress the spinal cord or individual nerve roots, leading to a variety of symptoms.

Stenosis is most commonly caused by age-related degenerative changes including:

• Thickening of ligaments within the spinal canal
• Facet joint arthritis and bone spur formation
• Disc bulging or herniation
• Loss of disc height leading to altered spinal mechanics

Spinal stenosis typically develops gradually over years or decades. It is more common in the lumbar (lower back) and cervical (neck) regions.

Stenosis can occur in different parts of the spinal canal, and these distinctions are important for understanding symptoms and guiding treatment:

• Central stenosis: narrowing in the main spinal canal. This can affect multiple nerves at once (neurogenic claudication), or in the neck, the spinal cord itself (myelopathy).
• Lateral recess stenosis: narrowing in the area where individual nerve roots begin to exit the spinal canal.
• Foraminal stenosis: narrowing of the openings (foramina) where nerves exit the spine.

Both lateral recess and foraminal stenosis typically affect a single nerve root, often leading to more localized symptoms such as sciatica in the leg or radiating pain in the arm.

Symptoms of spinal stenosis vary depending on the location and severity of the narrowing.

Lumbar stenosis (lower back) may cause:

• Neurogenic claudication: Leg pain, heaviness, numbness, or weakness that worsens with walking or prolonged standing and improves with sitting or forward bending
• Difficulty walking long distances
• Balance problems or unsteady gait
• Localized lower back pain (though this is not always present)
• Symptoms often affect both legs, though one side may be worse than the other

Cervical stenosis (neck) may cause:

• Arm pain, numbness, or weakness
• Hand clumsiness or difficulty with fine motor tasks
• Balance difficulties or unsteady walking
• Neck pain or stiffness
• In severe cases, symptoms of spinal cord compression (myelopathy) including progressive weakness, gait disturbance, or loss of coordination

The majority of patients with spinal stenosis can be managed conservatively. Surgery is not indicated in the following situations:

Surgery for spinal stenosis is considered when conservative management has been appropriately attempted and symptoms significantly limit function.

Surgical consultation may be appropriate when:

The treatment of spinal stenosis at CSI follows a structured, evidence-based approach.

Initial Assessment

Comprehensive evaluation to:

• Establish the diagnosis and severity of stenosis
• Correlate imaging findings with clinical symptoms
• Identify any red flags requiring urgent intervention
• Determine the most appropriate initial treatment pathway

Investigations

Diagnosis begins with a detailed clinical evaluation and neurological examination. Imaging studies are used to confirm the diagnosis and assess severity:

• MRI (most common): shows nerves, discs, and soft tissues
• CT scan: useful in certain cases to evaluate bone structures
• X-rays: may help assess alignment or instability

Degenerative changes are commonly seen in individuals without symptoms. Imaging findings must always be interpreted in the context of the patient's clinical presentation.

For most patients, conservative care is initiated and may include:

Interventional Treatments

• Epidural steroid injections (foraminal, epidural, caudal blocks)
• Facet blocks (steroid, various ablation techniques)

If symptoms do not improve adequately with conservative care, reassessment determines:

• Whether continued conservative management with modifications is appropriate
• Whether alternative non-operative treatments should be considered
• Whether surgical consultation is warranted based on symptom severity and functional impact

When surgery is appropriate, CSI provides minimally invasive decompressive procedures including:

The specific technique is chosen based on the location and nature of the stenosis, the presence of instability, and the patient's overall spinal anatomy.

Following surgery, patients work with CSI Physio to:

• Restore mobility and strength
• Progress activity levels safely
• Address any underlying movement patterns that may have contributed to the condition
• Support long-term spine health

Spinal stenosis varies widely in its presentation, severity, and impact on function. Treatment must be individualized based on the patient's specific symptoms, functional limitations, imaging findings, and response to conservative care.

CSI's approach prioritizes accurate diagnosis, appropriate conservative management, and selective surgical intervention when clearly indicated.

If you have been diagnosed with spinal stenosis or are experiencing symptoms consistent with this condition, we welcome the opportunity to provide a comprehensive evaluation.