Spinal Stenosis

Overview

Crucial: the right treatment at the right time

Schoen Clinic London specialises in the treatment of acute and chronic disc herniation (disc prolapse). Whether you need an exact diagnosis, conservative treatment or precise disc surgery – you will benefit from the experience of our spine specialists.

Spinal Stenosis Symptoms

In lumbar spinal stenosis, the spinal nerve roots and/or cauda equina become compressed by the narrowing of the spinal canal. This is as a result of the enlargement of the joints in the spine bony overgrowths (osteophytes) which grow into the spinal canal. This is made worse by buckling of the ligamentum flavum and/or bulging of the discs.

When nerves are compressed they can produce symptoms of pain, numbness or tingling in the area of the leg that the particular spinal nerve supplies. In rare cases they can produce severe pain and even weakness in the legs, such that the ‘legs don’t work’. In most cases, the symptoms are produced when standing or walking and are relieved by sitting or bending forward. In rare cases the nerves which control your bladder, bowel and sexual function can be compressed. This is known as cauda equina syndrome (CES) and often requires urgent surgical intervention. Fortunately, immediate spinal surgery is only necessary in a few cases.

Spinal canal stenosis in the lumbar spine:

• Your legs feel heavy, painful and numb
• You often have to stop when walking
• Bending over forward relieves pain, so you tend to bend over when walking or support yourself on a shopping trolley

Spinal Stenosis Treatment

Diagnosing spinal canal stenosis requires experience. There are many symptoms of spinal canal stenosis and the condition can often be overlooked. With thorough diagnostic tests, we can find the cause of your problems and initiate the appropriate treatment.

Every diagnosis at Schoen Clinic London begins with an extensive consultation and a thorough physical examination. After assessment we can confirm the diagnosis with imaging methods and precisely determine the location and extent of the narrowing.

Narrowing of the vertebral canal can be best detected with magnetic resonance imaging (MRI). In this procedure, we can optimally visualise the spinal canal and the neural structures such as the spinal cord and nerve roots that pass through it. On occasions we may have to perform other tests such as a CT scan or neurophysiology testing.

Treatment Options

Once we have diagnosed that you have spinal canal stenosis, we use various treatment methods, depending on the severity and the symptoms. Our consultants and therapists will develop an individual treatment concept for you.

If the narrowing of the vertebral canal is not yet very advanced, conservative measures such as physiotherapy can often help. The goal of our treatment programme is to relieve your pain significantly and improve your quality of life.

In some cases, spinal injections, that can be performed as a day case procedure, may be appropriate and can relieve some of the acute pain.

In many cases most conservative treatments (manipulation, physiotherapy, medication or injections) are unlikely to be of much long-term benefit, and the symptoms rarely improve permanently without surgery to take the pressure off the nerves (decompression).

The objective of surgery is to remove the material (for example the excess bone and ‘thickened’ ligament) from the back of the spinal canal to give the nerve roots and/or cauda equina more room.

The nature of spinal surgery is not to ‘cure’ and it cannot prevent further degeneration of the spine but is aimed at providing benefit with a good percentage improvement and relief of leg symptoms. Good relief from leg symptoms following decompression surgery usually occurs in approximately 70–80% of cases. This is not necessarily felt immediately, but over a period of time, often several months.

Aftercare

It is very normal to experience some level of discomfort/pain after the surgery. The experienced nursing and medical staff at Schoen Clinic will help you to control this with appropriate medication. The symptoms in your legs may fluctuate due to increased swelling around the nerves. This can take a few weeks to settle. The ward physiotherapist will visit you after your operation to teach you exercises and help you out of bed. They will show you the correct way to move safely. Once you are confident and independently mobile, you will be encouraged to keep as mobile as possible.