Spinal Stenosis

Spinal stenosis is narrowing of the spinal canal or the spaces where nerves exit — squeezing the spinal cord or nerves. It most commonly affects the lower back (lumbar stenosis) or neck (cervical stenosis). It typically develops gradually with age from arthritis and disc changes.

Symptoms — classic pattern

• Lumbar stenosis (lower back) — back, buttock, and leg pain/numbness/weakness with walking or standing ("neurogenic claudication"). Eases on sitting, leaning forward (stooping over a shopping trolley helps). Distinguishes from peripheral arterial claudication (which doesn't ease on sitting).
• Cervical stenosis — neck pain, arm numbness/weakness, clumsy hands, difficulty with fine tasks (buttons, keys). Leg weakness, balance problems, changes in bladder/bowel — suggest spinal cord compression — evaluate urgently.

Red flags — dial 112

• Numbness around the anus/genitals, loss of bladder or bowel control, progressive leg weakness — cauda equina.
• Cervical stenosis with progressive leg weakness or balance loss — cord compression — hospital.
• Severe pain with fever — rule out infection, including TB.

Diagnosis

Clinical history + examination; MRI is the key imaging. Nerve conduction studies/EMG may help distinguish from peripheral nerve disease.

Treatment

• Keep active; low-impact exercise (walking, swimming, stationary cycling with forward lean).
• Physiotherapy — core stability, flexion-biased exercise.
• NSAIDs, simple pain relievers, neuropathic pain medicines for specific symptoms.
• Epidural steroid injection — can relieve leg symptoms for months.
• Weight management, quit smoking, treat diabetes — help outcomes.
• Surgical decompression (laminectomy, sometimes fusion) — for significant persistent symptoms or neurological deficits; generally good results in well-selected patients.
• Be cautious with aggressive unproven spine injections from unqualified practitioners — seek qualified orthopaedic/neurosurgical opinion.