Lumbar Spinal Stenosis and Its Treatment

Lumbar spinal stenosis is a chronic condition in which ageing and degenerative changes narrow the spinal canal in the lower back and compress the nerves. It causes numbness, pain and weakness in the legs after walking a certain distance; sitting and leaning forward relieve symptoms. Depending on the patient’s condition, treatment involves non-surgical (conservative) methods, interventional pain procedures or microsurgery.

What Is Lumbar Spinal Canal Narrowing, and What Causes It?

The spinal cord and the nerve roots branching from it towards the legs pass through a protective tunnel formed by the stacked vertebrae: the spinal canal. With ageing, repeated loading and minor strains, the facet joints and discs surrounding this canal gradually wear down. Although increasing age is the greatest factor, we also encounter this condition in younger patients who perform heavy physical work or carry heavy loads without proper control. Following this wear, degenerative bony changes (osteophyte formation) and ligament thickening gradually narrow the diameter of the spinal canal. The nerve roots travelling through the canal towards the legs are eventually mechanically compressed.

What Are the Symptoms of Spinal Stenosis?

The condition develops insidiously and progresses over years. Its most characteristic clinical feature is neurogenic claudication (leg pain and weakness triggered by walking):

• After walking a certain distance, the patient develops leg numbness, heaviness, burning and weakness.
• The person feels the need to lean forward or sit and rest; resting temporarily eases symptoms.
• As the condition progresses, the distance the patient can walk without stopping becomes increasingly shorter.

How Is Spinal Stenosis Diagnosed?

Diagnosis begins with a detailed history, including walking distance, and an examination. Lumbar MRI is the most important imaging method, allowing canal diameter to be measured in millimetres; however, the degree of narrowing on MRI does not always reflect symptom severity. CT may be requested to show bony degenerative changes more clearly. EMG is not needed in every patient and is requested when the diagnosis is uncertain.

Treatment Methods for Spinal Stenosis

1. Conservative Treatments

These are first-line treatments for our early-stage patients whose walking distance remains preserved and who have not yet reached the threshold for surgery:

• Medication: Medicines do not reduce nerve compression; they aim to relieve pain.
• Weight Management: Nutritional counselling to reduce the mechanical load on the spine.
• Physiotherapy and Rehabilitation: Clinical exercises that strengthen the muscles around the spine and reduce stress on the canal; guidelines recommend this first-line approach together with education and home exercise [5].
• Patient Education: Teaching correct posture and movement patterns to protect spinal health in daily life.

2. Interventional Pain Treatments

These are combined with conservative care when that alone is insufficient or when we want to improve comfort rapidly:

• Epidural Injection (Targeted Treatment): Under real-time imaging, the narrowed area is reached directly and an epidural injection is performed to relieve the nerve roots, as in targeted treatment for lumbar disc herniation. The injection does not eliminate the narrowing; its purpose is to relieve leg pain and limitations during walking [1, 2].
• Radiofrequency Facet Joint Denervation: If severe lower back and joint pain due to facet syndrome (lumbar osteoarthritis) accompanies stenosis, radiofrequency facet joint denervation can be performed in the same session to reduce lower back pain. This targets facet-joint-related pain, not the canal narrowing itself [3].

3. Surgical Methods

The boundary between non-surgical treatment and surgery is determined by considering symptom severity, limitations in daily life, neurological examination and MRI findings together. Markedly reduced walking distance, emerging leg weakness or impaired bladder/bowel control bring surgery into consideration; rapidly progressing weakness and new loss of bladder/bowel control require urgent assessment.

• Bilateral Decompression Through a Unilateral Approach (UBL) — Spinal Stenosis Surgery Without Screws: This method removes only the structures compressing the nerve while largely preserving the supporting bone and muscle tissues at the back of the spine.

🩺 Physician’s Insight & Clinical Experience

“In my practice, the sentence I hear most often from patients with spinal stenosis is: ‘Doctor, I used to walk to the market; now my legs become numb before I reach the local shop, and I have to stop and bend forward.’ This condition is insidious; the nerve is gradually compressed. In my practice, changes in walking distance are an important monitoring measure, though not a sole basis for decisions. When deciding on surgery, we assess them alongside neurological examination, effects on daily life and imaging findings. If walking distance has shortened markedly and progressively, unnecessarily delaying surgery may increase the risk of permanent nerve damage. I closely monitor these changes through the patient’s functioning in daily life.”

Frequently Asked Questions

What Happens If Spinal Stenosis Is Not Treated?

Spinal stenosis does not resolve on its own; in some patients, it progresses over the years and increasingly reduces walking distance. Prolonged nerve compression can cause leg weakness, permanent numbness and severe limitations in daily life.

At What Stage Is Surgery Needed?

Surgery is needed if walking distance has fallen below 100 metres, leg weakness has begun or non-surgical treatments have failed. The decision is based not on MRI alone but on limitations in daily life and neurological examination.

When Are Metal Implants (Screws) Needed in Spinal Stenosis Surgery?

Screws are not necessary in every operation. They are used to preserve spinal stability when there is vertebral slippage (spondylolisthesis), curvature (scoliosis), or a need to remove a large amount of bone to decompress the canal during surgery. In a stable spine, widening the canal (decompression) alone is often sufficient.

How Does Spinal Stenosis Differ from Lumbar Disc Herniation?

Lumbar disc herniation usually begins suddenly and can occur at any age, while spinal stenosis typically develops over years in people over 50. Herniation pain may persist at rest; stenosis symptoms increase with standing and walking and decrease with sitting and leaning forward.

Can an Epidural Injection Solve Spinal Stenosis?

It is not a permanent solution, but it may temporarily relieve walking-related leg pain and limitations in some patients. Evidence is conflicting: some studies report long-term benefit with caudal and interlaminar injections [1, 4], whereas a current guideline summary found possible improvement in disability but no demonstrated pain benefit [2], and a clinical guideline recommended against epidural steroids [5]. Radiofrequency can be added for accompanying facet-related lower back pain; its effect may last up to 12 months in suitable patients [3].

Does Spinal Stenosis Cause Paralysis?

No, it does not cause paralysis in most patients and usually progresses slowly. However, nerve damage may become permanent if weakness is not taken seriously. Rapidly progressing weakness or new loss of bladder/bowel control requires urgent assessment.

Does Nucleoplasty Help Spinal Stenosis?

Usually not. Nucleoplasty mainly targets disc herniation; in spinal stenosis, the main problem is thickening of bone and ligaments rather than disc tissue. It is therefore not the first choice for isolated stenosis. If a significant disc herniation is also present, treatment selection is assessed separately, taking this additional condition into account.

Which Specialist Treats Spinal Stenosis in Istanbul?

One of the physicians treating spinal stenosis in Istanbul is M. Levent Deniz, MD, a specialist in brain, nerve and spine surgery.

How Much Does Spinal Stenosis Treatment Cost?

As treatment costs vary according to the patient and hospital conditions, a definite fee can only be determined after examination and review of imaging.

References

1. Manchikanti L, Kaye AD, Manchikanti K, Boswell M, Pampati V, Hirsch J. Efficacy of epidural injections in the treatment of lumbar central spinal stenosis: a systematic review. Anesth Pain Med. 2015;5(1):e23139. PMID: 25789241. PubMed
2. American Academy of Neurology Guidelines Subcommittee. Epidural Steroids for Cervical and Lumbar Radicular Pain and Spinal Stenosis Systematic Review Summary: Report of the AAN Guidelines Subcommittee. Neurology. 2025. PMID: 39938000. PubMed
3. Lee CH, Chung CK, Kim CH. The efficacy of conventional radiofrequency denervation in patients with chronic low back pain originating from the facet joints: a meta-analysis of randomized controlled trials. Spine J. 2017;17(11):1770-1780. PMID: 28576500. PubMed
4. Kaye AD, Manchikanti L, Abdi S, et al. Efficacy of Epidural Injections in Managing Chronic Spinal Pain: A Best Evidence Synthesis. Pain Physician. 2015;18(6):E939-E1004. PMID: 26606031. PubMed
5. Bussières A, Cancelliere C, Ammendolia C, et al. Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical Practice Guideline. J Pain. 2021;22(9):1015-1039. PMID: 33857615. PubMed

• 👨‍⚕️ Author and medical reviewer of this content: M. Levent Deniz, MD – Brain, Nerve and Spine Surgeon
• ⚠️ Medical Disclaimer: This page is for information only; consult your doctor for diagnosis and treatment.