Spinal Stenosis

• Spinal stenosis refers to the narrowing of part of the spinal canal, resulting in compression of the spinal cord or nerve roots
• Spinal stenosis usually affects the cervical or lumbar spine
• Lumbar spinal stenosis is the most common type of spinal stenosis
• Spinal stenosis is more likely to occur in patients older than 60 years, relating to degenerative changes in the spine
• Types of spinal stenosis

  • Central stenosis
  • Lateral stenosis
  • Foramina stenosis
• Causes of spinal stenosis

  • Congenital spinal stenosis
  • Degenerative changes including facet joint changes, disc disease, and bone spurs
  • Herniated discs
  • Thickening of the ligamenta flava or posterior longitudinal ligament
  • Spinal fractures
  • Spondylolisthesis (anterior displacement of a vertebra out of line with the one below)
  • Tumours
• Symptoms of spinal stenosis tend to have a gradual onset
• The severity of symptoms of spinal stenosis will depend on the degree of narrowing and spinal cord
• Severe compression of the spinal cord can present with features of cauda equina syndrome (saddle anaesthesia, sexual dysfunction, and incontinence of the bladder and bowel), requiring emergency management
• Intermittent neurogenic claudication is a key presenting feature of lumbar spinal stenosis with central stenosis
• Cauda Equina Syndrome

  • Saddle anaesthesia
  • Sexual dysfunction
  • Incontinence of the bladder and bowel
• Intermittent Neurogenic Claudication

  1. Key presenting feature of lumbar spinal stenosis with central stenosis

  2. Sometimes referred to as pseudoclaudication

  3. Typical symptoms include lower back pain, buttock and leg pain, leg weakness

  4. Symptoms are absent at rest and when seated but occur with standing and walking

  5. Bending forward (flexing the spine) expands the spinal canal and improves symptoms

  6. Standing straight (extending the spine) narrows the canal and worsens the symptoms
• Lateral Stenosis and Foramina Stenosis in the lumbar spine


  • Cause symptoms of sciatica
• Radiculopathy

  Compression of the nerve roots as they exit the spinal cord and spinal column, leading to motor and sensory symptoms
• Important to spot the typical symptoms of intermittent neurogenic claudication for exams
• Peripheral pulses or the ankle-brachial pressure index (ABPI) being normal indicates spinal stenosis rather than peripheral arterial disease
• Patients with spinal stenosis are more likely to struggle with back pain compared to peripheral arterial disease
• Investigations for Spinal Stenosis

  1. MRI is the primary imaging investigation

  2. Investigations to exclude peripheral arterial disease may be appropriate where symptoms of intermittent claudication are present
• Management of Spinal Stenosis

  1. Guided by a spinal specialist based on individual factors

  2. Options include exercise and weight loss, analgesia, physiotherapy, decompression surgery, laminectomy
• Laminectomy


  Refers to the removal of part or all of the lamina from the affected vertebra
• Epidural injections with local anaesthetic and corticosteroids are not generally used for spinal stenosis