For appointments or confidential discussion call
London Clinic 07776 511824
Norwich Clinic 01603 505063

The London Norwich Spine Clinic is based at
Hospital of St Johns & St Elizabeth, St Johns Wood, London
and the Spire Norwich Hospital, Norwich.
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Information for GPs

Your spine is one of the most important and complex parts of your body - keeping it healthy is vital if you want to lead an active and pain free life.

Spinal Stenosis

Stenosis is the medical term for narrowing of the spinal canal becomes restricted by overgrowth of bones, ligaments or discs that press on the nerves.

Although it can occur in any part of the spine, the lower back (lumbar) and neck (cervical) areas are most commonly affected.

Causes

This narrowing occurs in late middle-aged and elderly people as their spine degenerates, due to:

  • Years of wear and tear on the back
  • Weakened vertebrae rubbing against each other, causing growths called bone spurs
  • Ligaments losing their elasticity and becoming stiff and thick
  • Diseases of the bone, such as Paget's disease
  • Osteoarthritis

Symptoms

These vary depending on the severity and location of the stenosis. If in the lower back, legs are mainly affected. In the cervical spine, it can impact on both upper and lower limbs.

Signs may include:

  • Difficulty walking long distances and need to sit down frequently
  • Tendency to bend forward or crouch to relieve pain (as this opens up the spinal canal)
  • Pain, pins and needles, numbness or weakness in the legs when standing or walking
  • Unsteadiness, loss of balance, clumsiness or walking as if drunk
  • Tingling, pain, or numbness running down the arm into the hand, plus a loss of dexterity

About 80% of patients with spinal stenosis see their symptoms get worse over time. For most this is a gradual process but for a small group, the rate of progression can be rapid.

Diagnosis

Treatment options

Non surgical

Physiotherapy

This includes general aerobic conditioning (cycling, swimming, brisk walking), core stability exercises (to strengthen muscles around the tummy that support the spine) and a change of lifestyle.

Epidural injections

Injecting steroids and local anaesthetic into the spinal canal reduces inflammation and indirectly make more room for the nerves. Relief is temporary but the advantage is that injections can be repeated with few side effects.

Surgery

If pain relief and physiotherapy have failed and the pain is affecting your quality of life, surgery may be recommended. The aim is to relieve pressure in the lower back by removing the bone or ligament that is pressing on the spinal nerves. In selected cases the benefits of the surgical procedure significantly out weighs the disadvantages and can improve quality of life. This is well documented in the medical literature.

"I thought I'd have to have major back surgery and months of rehabilitation but with the procedure Mr Rai recommended, I was in and out of hospital in just two days and within eight weeks, back to my normal daily routine." Read case studies >

Case studies

Mr L, aged 48

Condition: Spinal stenosis

Treatment: Spinal decompression using an interspinous spacer

Mr Rai's notes

"An MRI scan showed that Mr L had two worn discs and his thecal sac containing the spinal nerves had narrowed. In this case conservative treatment failed. He expected to undergo back surgery and months of rehabilitation, however thanks to a pioneering new procedure using an X-STOP interspinous spacer device, I was able to treat Mr L without a major operation.

He was consented for decompressive surgery. This was possible using a spacer device which was inserted into the lower vertebrae to act as a supportive spring mechanism, relieving nerve pressure and pain. The advantages are that it involves just a small incision, and can usually be done as a day procedure.

The patient's experience

"When the back pain started I was pretty sure it was due to all the years of hard physical labour building up my engineering company and then renovating my home. So I ignored it and kept going. For two years I took anti-inflammatory painkillers but without them the pain was unbearable. The problem didn't go away, it just got steadily worse.

My whole life was affected. I love playing golf but had to stop and I couldn't work on the house. I'd always wanted to water ski but the back problem put an end to any hope of this. I couldn't even tie my shoe laces. Just standing too long caused my legs to tingle and I had to sit.

It was a shock to hear that at 48 I had the spine of a 65 year old, mainly due to the wear and tear on my back from years of heavy physical work. It's a salutary lesson for those in the building industry - take good care of your back.

I thought I'd have to have major back surgery and months of rehabilitation that would end my renovation project but Mr Rai suggested I have a device called an X-STOP implanted in my spine.

I was in and out of hospital in just two days and within eight weeks I was back to my normal daily routine and able to lift heavy loads.

I am delighted with the result. I can play golf again and looking forward to starting to water ski but most importantly I can finish my house!

I'm only in my late 40s and I've a lot more life to lead.

I thought I'd have to have major back surgery and months of rehabilitation but with the procedure Mr Rai recommended, I was in and out of hospital in just two days and within eight weeks, back to my normal daily routine"

Mrs E, aged 68

Condition: Spinal stenosis

Treatment: Spinal decompression surgery

The patient's experience

"I had a bout of sciatica which never really cleared, even with regular visits to a chiropractor. A sudden twist or turn would stop me straightening up and I frequently resorted to ibuprofen tablets.

However, things suddenly got much worse and I found myself in excruciating agony, unable to straighten, walk or lie down, without nerves screaming all the way down to my fingers and toes.

It was a deteriorating existence - I could only walk fifty yards at the most and stand for only a few seconds without leaning on something.

By this time I was seeing a physiotherapist, who organised an MRI scan. Armed with the results I made an appointment to see Mr Rai (highly recommended by many people I met) and he diagnosed severe spinal stenosis.

Six weeks later, I had decompressive surgery. I had complete confidence in the procedure, because Mr Rai made it sound so routine and manageable and the obvious solution to my problem.

Immediately after coming round, I experienced the joy of being able to stretch in a way that had been impossible for years. Within hours I was standing and walking and after four nights in hospital, I went home confident of being able to manage.

Just two weeks later, I was walking half a mile to get my daily paper and happily standing to chat to people.

To anyone who has the chance of improving their existence with back surgery, I'd say 'go for it!' Mr Rai, with his expertise, has given me back my life and I will be forever grateful."