Spinal Stenosis
Spinal stenosis is one of the most common causes of low back pain and walking limitation in adults, particularly in people over 50 years of age.
It is a condition that can significantly affect everyday life but can be managed effectively when diagnosed early and treated in an individualised way. Surgery is not always required, and each case is assessed in its entirety.
What is spinal stenosis?
The spinal canal is the channel through which the spinal cord and nerve roots pass. When the available space within this canal is reduced, whether due to degenerative changes or other causes, the neural structures are compressed and the characteristic symptoms of the condition appear.
The condition is most often located in the lumbar spine, but it can also affect the cervical spine, each with a different clinical picture.
It is worth clarifying that the term “narrowing of the intervertebral disc”, which some patients use, is not a precise medical term. The stenosis concerns the spinal canal and the exit foramina of the nerve roots, not the disc itself. However, disc degeneration is one of the main factors contributing to the development of stenosis.
Symptoms
How does spinal stenosis present?
The symptoms of spinal stenosis are often characteristic and differ from those of other spinal disorders. The most common include:
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Pain, a feeling of heaviness or cramp in the buttocks, calves or the whole lower limb, which worsens with walking or prolonged standing.
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Numbness and paraesthesiae in the lower limbs.
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A characteristic limitation of the distance the patient can walk before needing to stop.
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Low back pain accompanying the leg symptoms.
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Muscle weakness in the legs in more advanced cases.
Neurogenic claudication
One of the most recognisable features of the condition is so‑called neurogenic intermittent claudication. Patients report that they can walk further when they lean slightly forwards, for example when pushing a supermarket trolley, whereas standing upright and walking downhill aggravate their symptoms.
This is because flexion of the spine temporarily increases the available space within the canal.
In rare but serious cases, disturbances of bladder or bowel function may occur, which require urgent medical assessment.
Causes and risk factors
The most common cause of spinal stenosis is degenerative change that develops over time. Specifically, facet joint hypertrophy, thickening of the ligamentum flavum, disc degeneration and osteophyte formation gradually reduce the available space in the spinal canal.
Beyond degenerative changes, other causes include spondylolisthesis, scoliosis, a congenitally narrow canal, and more rarely trauma or spinal tumours.
Diagnostic approach
Diagnosis of spinal stenosis is based on a combination of detailed history, clinical examination and imaging findings.
Magnetic resonance imaging (MRI) is the investigation of choice, as it clearly demonstrates the degree of stenosis and the relationship between bony, disc and ligamentous structures and the nerve roots.
Computed tomography (CT) is used as a complementary tool to assess bony anatomy, while CT myelography is performed in selected cases.
Differential diagnosis
Several conditions can cause symptoms similar to spinal stenosis and require careful differentiation.
The most important is vascular claudication, which is due to ischaemia of the lower limb muscles from peripheral arterial disease. In vascular claudication, pain is relieved simply by standing still, without the need to bend forwards, and is accompanied by diminished distal pulses.
Other conditions to consider include peripheral neuropathies such as diabetic neuropathy, radiculopathies due to a single disc prolapse, and myopathies or hip and knee arthropathies that limit walking distance.
The clinical picture, palpation of pulses, response to postural change and imaging findings are crucial for correct distinction and lead to completely different therapeutic strategies in each case.
Treatment
Treatment of spinal stenosis is individualised according to symptom severity, degree of stenosis, age and the overall condition of the patient.
Conservative management
In mild cases, treatment begins with conservative measures. Targeted physiotherapy focusing on core muscle strengthening, improved flexibility and posture training is the cornerstone of non‑operative care.
At the same time, medication with analgesics, anti‑inflammatories and drugs for neuropathic pain helps to control symptoms. Weight management and optimal control of co‑existing conditions such as diabetes also improve function.
Targeted injections
When conservative measures are insufficient, epidural or foraminal corticosteroid injections provide focused anti‑inflammatory action and short‑term relief. Beyond their therapeutic value, they are also diagnostically useful, as they confirm which nerve root or level is responsible for the symptoms.
Surgical treatment
Surgery is considered when symptoms persist despite adequate conservative management and significantly impair quality of life. Progressive neurological deterioration, marked muscle weakness or sphincter disturbance are clear indications for surgical decompression.
In addition, in cases of cauda equina syndrome with severe bladder and bowel dysfunction, surgery is an emergency.
Decompression and fusion
The classic surgical approach is decompressive laminectomy, in which the bony and ligamentous structures compressing the nerve roots are removed. When spinal instability or spondylolisthesis is also present, decompression is combined with spinal fusion to restore stability.
Modern minimally invasive techniques, such as microsurgical decompression, achieve the same goals with smaller incisions, less postoperative pain and faster recovery.
Choice of technique depends on the anatomy, the number of affected levels and the patient’s overall condition.
Prognosis and follow‑up
Many patients with spinal stenosis maintain stable or mild symptoms with appropriate conservative management and lifestyle adjustments. In those undergoing appropriate surgical decompression, improvement in walking distance and quality of life is often significant.
However, complete disappearance of all symptoms is not always possible, particularly in very advanced degenerative disease or when multiple comorbidities are present.
Long‑term follow‑up by a specialist spinal surgeon is helpful for early recognition of symptom recurrence, development of stenosis at adjacent levels or progression of associated conditions.
Appointments
Athens and Thessaloniki
If you are experiencing symptoms of spinal stenosis or already have imaging findings that require assessment, you can get in touch to arrange an appointment.
The aim of the first consultation is to provide thorough information on the available options and to plan the most appropriate treatment strategy.