Spinal stenosis

Rapid assessment, diagnosis and treatment

Degenerative changes in the spine can constrict the spinal canal, leading to the development of back and leg pain, numbness in the legs and reduced mobility.

At Schoen Clinic, our team of spinal experts specialise in the diagnosis and treatment of all aspects of back diseases, brought on by wear and tear, or other causes. Whether conservative treatment or surgery – we will always advise on the right treatment for you.

What is spinal stenosis?

In lumbar spinal stenosis, the spinal nerve roots and/or cauda equina become compressed by the narrowing of the spinal canal. In cases of spinal stenosis, this narrowing can be the result of overgrowth of bone, or 'bone spurs' (osteophytes) protruding into the spinal canal. This is made worse by the 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.

Signs of spinal canal stenosis in the lumbar

  • 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

Causes: how does spinal canal stenosis develop?

Spinal canal stenosis can be either congenital or acquired.
In congenital spinal stenosis, the bony bridges (pedicles) between the vertebral bodies and the vertebral joints along the entire spine are too short. Problems begin to develop at just a young age.
Acquired spinal stenosis occurs primarily in the lumbar spine and the cervical spine. The main cause is age-related wear and tear of the discs. One of five persons over age 60 has this kind of narrowing.
  • Acquired spinal stenosis

Diagnosing spinal stenosis requires experience

There are many symptoms of spinal canal stenosis and they can also fit other diseases of the spine. 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. Whether you need an exact diagnosis, conservative treatment or precise disc surgery – you will benefit from the experience of our spine specialists.

Thorough examinations are the basis

Every diagnosis at Schoen Clinic begins with an extensive talk and a thorough physical examination. For example, we provoke the symptoms you describe by carefully bending your trunk. If you have severe pain, we can confirm the diagnosis with imaging methods and precisely determine the location and extent of the narrowing.

Imaging methods. MRI or CT make the spinal canal stenosis visible

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.

Surgery is not always necessary

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.

Spinal injections

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

Lumbar Spinal stenosis surgery

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 of 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: Smooth return to everyday life

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.

Spinal stenosis: Our specialists

Whether you need an exact diagnosis, conservative treatment or precise disc surgery – you will benefit from the experience of our spine specialists.

Dr Roger Wolman

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant - Rheumatology

Consultant - Sports & Exercise Medicine

Consultant Rheumatology and Sport & Exercise Medicine
MD (Res) FRCP FFSEM
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Mr Peter Hamlyn

Schoen Clinic Orthopaedic and Spinal Hospital London

Head of Department - Back & Spine

Consultant Neurosurgeon
MB BS BSc MD FRCS FISM
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Mr Colin Natali

Schoen Clinic Orthopaedic and Spinal Hospital London

Head of Department - Back & Spine

Consultant Orthopaedic Surgeon
MBBS FRCS FRCS (Orth)
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Mr Stewart Tucker

Schoen Clinic Orthopaedic and Spinal Hospital London

Head of Department - Back & Spine

Consultant Orthopaedic Surgeon
MBBS FRCS(Eng) FRCS(Orth)
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Mr Hanny Anwar

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Back & Spine

Consultant Orthopaedic Surgeon
BMedSci MBBS MRCS FRCS(Tr&Orth)

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Mr David Cumming

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Back & Spine

Consultant Orthopaedic Surgeon
MBChB FRCS(Tr&Orth)
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Mr Irfan Malik

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Back & Spine

Consultant Neurosurgeon
MBBS, FRCS, FCPS, FRCS(SN), MSc
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Mrs Anne Mitchener

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Neurosurgeon - Back & Spine

Consultant Neurosurgeon
BSc PhD MB BCHIR FRCS FRCS(SN)
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Mr Alex Montgomery

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Back & Spine

Consultant Orthopaedic Surgeon
MBChB MRCS DIPL(Orth Eng) FRCS
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Mr Am Rai

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Back & Spine

Spinal Consultant
BM, FRCS, FRCS Orth
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Mr Vittorio Russo

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Neurosurgeon - Back & Spine

Consultant Neurosurgeon
MD

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Mr Rohit Shetty

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Back & Spine

Consultant Orthopaedic Surgeon
MS(Orth) DNB(Orth) FRCS(Tr&Orth) Dip(Tr&Orth)
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Mr Alagappan Sivaraman

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Back & Spine

Consultant Orthopaedic Surgeon
FRCS (Eng) FRCS (Ed) FRCS (Orth)
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Dr Philip Batty

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant - Sports & Exercise Medicine

Consultant Sport and Exercise Physician
MB ChB, MRCGP, FFSEM
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Spinal stenosis: Our specialised hospital

Schoen Clinic specialises in the treatment of acute and chronic disc herniation (disc prolapse).

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Authors, 09.06.2020