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Narrowing of the spaces the spinal nerves run through. The classic sign is leg pain or heaviness on walking that eases when you sit down or lean forward — which is also how it is told apart from poor circulation.
The spinal nerves run down a central canal and leave through openings at each level. Spinal stenosis is narrowing of those spaces, enough to squeeze the nerves inside. It can affect the central canal, the side channels, or the openings where individual nerves leave.
It is most common in the lower back, where it is called lumbar spinal stenosis. In the neck it can press on the spinal cord itself — see cervical myelopathy — or on a single nerve root. It is uncommon in the upper back.
Most stenosis is the result of wear over decades: the small joints at the back of the spine enlarge with arthritis, a ligament inside the canal thickens, and discs flatten and bulge. Together they close the space from several directions at once.
On the left, the nerve roots sit in a canal with room to spare. On the right, bone overgrowth from the enlarged joints, a thickened ligament at the back and the bulging disc in front have closed in, squeezing the bundle into a flattened oval.
What the drawing cannot show is when it hurts. Standing and walking narrow the canal a little further, which is when symptoms come on; bending forward opens it slightly, which is why sitting or leaning on a trolley brings relief.
Narrowing on a scan is common in people who feel fine. Many older adults have some stenosis on MRI and no symptoms at all. It is the combination of symptoms, examination and scan that makes the diagnosis, not the scan alone.
Poor circulation to the legs (peripheral artery disease) also causes pain on walking, and it is common in the same age group. The two behave differently.
| Spinal stenosis | Poor circulation | |
|---|---|---|
| What eases it | Sitting down, or bending forward | Standing still is enough |
| Leaning on a trolley | Helps — you can often walk further | Makes no difference |
| Walking uphill | Often easier, because you lean forward | Harder |
| Cycling | Usually comfortable | Brings on the pain |
| What it feels like | Heaviness, numbness, tingling or weakness, often down the back of the legs | A cramping ache, usually in the calf |
| Pulses in the feet | Normal | Weak or absent |
The two can exist together, particularly in smokers and people with diabetes. Where there is doubt, checking the circulation is part of the assessment.
The examination is often normal at rest. Symptoms come on with walking and standing, so the description of what happens, how far you can walk and what relieves it carries much of the diagnosis.
Call us on +65 8849 0677. We will see you the same day and arrange imaging if it is needed.
If we are closed, go to an emergency department — we are shut on Sundays and after 1pm on Saturdays. For the first two symptoms, go straight to an emergency department whether we are open or not.
Call +65 8849 0677Stenosis usually changes slowly. Many people keep their symptoms under control for years without an operation; surgery is for those whose walking and daily life stay limited despite that.
Exercise that allows forward bending is usually best tolerated: cycling, walking with a stick or trolley, and swimming. Physiotherapy for core strength, flexibility and walking tolerance helps many people walk further.
Anti-inflammatories for flare-ups, and sometimes medicines aimed at nerve pain. These ease symptoms but do not change the narrowing.
A steroid injection around the squeezed nerves can give relief, often for weeks rather than months. For pain from stenosis, Dr Tung works with radiologists to offer CT-guided nerve root and facet blocks, and radiofrequency nerve ablation.
Considered when walking distance and daily life remain badly limited despite the steps above, when weakness is getting worse, or urgently for bladder or bowel symptoms. Surgery removes the bone and ligament that are narrowing the canal or the nerve openings.
Decompression reliably improves leg symptoms and walking; it helps back pain less predictably. More on the operation under decompression surgery.
For spinal stenosis, either is appropriate: both spine surgeons treat it. They come at it from different training.
Leg symptoms, numbness and weakness, and which nerves are squeezed.
A neurosurgeon trains on the nervous system first. Dr Mathew Tung offers CT-guided nerve interventions for stenosis pain, foraminotomy, and decompression with fusion.
The joints, alignment and stability of the spine — especially where stenosis comes with a slipped vertebra or a curve.
An orthopaedic spine surgeon trains on the musculoskeletal system first. Dr Lim Heng Hing treats spinal stenosis using endoscopic and robotic techniques.
You do not need to pick correctly. Either is a sound first appointment, and having both surgeons in one clinic means the answer is not shaped by whichever one you happened to book.
More on how the two differ: neuro spine and orthopaedic spine surgery.
Bending forward slightly widens the spinal canal and takes pressure off the nerves. That is why sitting, cycling or leaning on a trolley often eases symptoms that walking upright brings on.
Usually slowly, if at all. Many people stay about the same for years, and some improve. A minority worsen, which is why changes in walking distance or strength are worth reporting.
They are linked but not the same. Arthritis in the spine is one of the main causes of stenosis, but many people have arthritis without narrowing enough to squeeze the nerves.
Yes. It will not reverse the narrowing, but regular exercise — especially cycling, swimming and paced walking — helps many people walk further with less pain.
Most people do not. Surgery is for those whose walking and daily life remain badly limited despite non-surgical treatment, for weakness that is getting worse, or urgently for bladder or bowel symptoms.
No. Bring any MRI or X-ray reports, and note roughly how far you can walk before symptoms start and what relieves them.
Lower back pain · Sciatica · Slipped disc · Spondylolisthesis · Cervical myelopathy · Scoliosis · Facet joint syndrome · Foot drop
Before you come, notice how far you can walk and what makes it better. Those two details say more than most scans.
