Anatomical background

What is spinal stenosis?

The spinal canal is the bony-ligamentous channel through which the spinal cord and nerve roots travel. Wear of the discs and the resulting abnormal hypermobility (instability) can lead to overgrowth and hypertrophy of the connecting tissues — disc, ligaments, bone — narrowing the spinal canal or the exit foramina of the nerve roots.

Stenosis develops slowly, typically over years to decades, and can occur in both the cervical and lumbar spine — with different symptoms and a different treatment logic.

What the scan does — and doesn’t — mean

The degree of stenosis on the scan does not, by itself, decide treatment

Degenerative changes of the spine — including the processes that narrow the canal — are frequently visible on imaging in older people who have no symptoms at all. The word “stenosis” on a report, on its own and without symptoms, therefore does not amount to a condition that needs treatment.

The treatment decision always rests on the symptoms, the physical examination and the scan considered together — not merely on how severe the narrowing looks on the image. Marked stenosis can occur alongside mild symptoms, and vice versa. This is why appropriate treatment is always tailored to the individual.

First step

Non-surgical treatment — for mild to moderate cases

In mild and moderate spinal stenosis, treatment almost always starts non-surgically. Targeted CT-guided injection therapy, physiotherapy and conscious modulation of physical load often produce lasting improvement — particularly when the foraminal exits are narrowed rather than the central canal.

Non-surgical treatment is often sufficient

In mild and moderate stenosis, targeted injection therapy and a properly designed physiotherapy programme are often enough. Details of non-surgical treatment are available on the dedicated page.

How far does conservative treatment go?

It is important to understand that, unlike a disc herniation, spinal stenosis does not resolve on its own — the degenerative narrowing of the canal persists. The aim of conservative treatment is therefore not to “remove” the stenosis, but to control symptoms over the long term: easing pain, preserving walking distance and maintaining quality of life.

In mild and moderate cases this approach works well for a long time, and many patients manage for years without surgery — with targeted physiotherapy, pain relief and, where needed, injection treatment. Surgery comes into focus when symptoms continue to impair daily life despite conservative care.

Lumbar spine

Lumbar spinal stenosis

Lumbar stenosis has a characteristic clinical presentation: pain radiating into the leg, numbness and weakness develop while walking, after a shorter or longer distance. This is neurogenic claudication — a recognisable and well-treatable symptom complex.

Characteristic symptom: neurogenic claudication

Leg pain worsens with load — typically while walking — and eases within a short time on stopping or leaning slightly forward (for example, leaning on a shopping trolley). This symptom is often the most telltale sign of untreated stenosis.

Because the process develops slowly, urgent surgical indication rarely arises — there is time for gradual, targeted treatment.

Indication for surgery

Clinical signs of chronic nerve compression (radiculopathy, weakness, sensory disturbance)
Non-surgical treatment (targeted injection, physiotherapy) does not produce lasting improvement
Gradual deterioration — significant reduction in walking distance
Severe neurogenic claudication that impairs quality of life
MRI morphology shows significant stenosis

Surgical technique: posterior decompression and recalibration

A 3–4 cm midline skin incision is made on the back of the lumbar spine; the muscles are retracted and the spine is exposed. A bony window (laminotomy) is opened on the posterior aspect of the spine, through which the nerve roots and the dural sac are decompressed — "recalibrating" the canal for the nerves.

If instability accompanies the stenosis, segmental stabilization (fusion surgery) may also be needed. The decision is always made individually, based on MRI and dynamic X-ray.

Cervical spine

Cervical spinal stenosis

Cervical stenosis can have more serious consequences than the lumbar form, because direct compression of the spinal cord can occur here. The range of symptoms is broader: gait disturbance, loss of hand dexterity, balance problems, and in more severe cases limb weakness — collectively known as myelopathy.

Indication for urgent surgery

Pain unresponsive to medication
Rapidly developing or worsening upper and/or lower limb weakness
Clinical signs of acute spinal cord compression

Indication for planned surgery

Clinical signs of chronic spinal cord compression (myelopathy)
Persistent symptoms unresponsive to non-surgical treatment
Gradual but clear deterioration
MRI shows significant stenosis consistent with the symptoms

What to expect from surgery, and how urgent is it?

If conservative treatment does not bring enough relief, decompression surgery is a reliable solution: by freeing the compressed nerves, large international studies show it meaningfully improves pain, walking distance and movement function — and this advantage remains measurable years after the procedure.

In the absence of red flags — such as acute, progressive neurological symptoms — surgery is not, however, urgent. The decision is unhurried and is made together with the patient: there is time to work through the conservative options, and in most cases a delay does not rule out successful surgery later. This is exactly why it is worth turning to a surgeon who genuinely weighs the non-surgical path as well.

Anterior approach: discectomy and fusion

Through a 3–4 cm skin incision in the front of the neck, the spine is exposed, the disc is removed and the neural elements are decompressed. A cage with bone-graft substitute is placed in the position of the disc, providing stability and allowing the vertebrae to fuse. The procedure can be performed on up to four adjacent segments.

Posterior approach: decompression and stabilization

For multi-level stenosis or particular morphological features, the procedure is performed via a posterior approach. Through a midline incision on the back of the neck, the spine is exposed and a central laminectomy decompresses the spinal cord and nerve roots. If needed, the segments are stabilized with titanium screws and rods, secured with bone-graft substitute to ensure lasting fusion.

Patient cases

Two typical patient journeys

Treatment of spinal stenosis depends on the severity of the condition. The composite cases below illustrate both logics: the non-surgical path, where targeted injection and physiotherapy are sufficient, and the surgical solution, where these do not bring improvement.

Non-surgical success

"My leg hurt more and more when I was walking"

A woman in her 70s with adult scoliosis and foraminal stenosis. After a series of CT-guided injections and targeted physiotherapy, she became lastingly symptom-free — without surgery.

Read full case

Surgical solution

"I could walk less and less"

A 68-year-old, previously active man with significant neurogenic claudication. Non-surgical treatment did not bring improvement — after decompression surgery, he regained his ability to walk.