Performed by – Sri Chatakondu, Sarmad Kazzaz, Mark Thomas, Adam Way

What is spinal stenosis?
The spinal canal transmits a sheath which contains nerve rootlets bathed in fluid (CSF). The canal is bounded at the front by the verterbral bodies and intervertebral disc and at the back by bridges of bone (laminae) separated by a ligamentous membrane ( ligamentum flavum) and the facet joints.

As the disc degenerates with age it loses height and bulges backwards. This allows the ligamentum flavum to buckle inwards. Corresponding arthritic change in the facet joints causes them to enlarge and encroach upon the spinal canal. One or all of these changes can occur to cause a narrowing of the spinal canal and compression of the nerves. This is known as spinal stenosis.

What are the symptoms?
Classically the symptoms are of leg ache, fatigue, weakness, numbness and pins and needles that come on after standing or walking and progressively build up in intensity with time. Often the symptoms reverse on sitting or leaning forward but as the condition progresses they can become constant. Back pain may or may not be associated with spinal stenosis.

What treatment is there?
Painkillers: Often there is an inflammatory component to the pain so simple painkillers and anti-inflammatories may be beneficial in the early stages

Physiotherapy: In the early stages physiotherapy may be beneficial. The mechanism of benefit is not clear. My personal view is that building up the muscles that support the spine may prevent some of the spinal canal narrowing that occurs on standing or walking.

Epidural injection: again because of the inflammatory component a cortisone injection around the nerve roots may give relief of symptoms. If there is only temporary relief, then this still confirms the diagnosis and predicts a more successful outcome from surgery.

Facet joint injections: In the presence of back pain it is sometimes difficult to decide whether the leg ache is due to nerve compression or whether it is being referred down the leg from painful arthritic facet joints. It may be advisable to perform cortisone injections into the facet joints to try and work out whether your back pain is coming from this source.

If these non-operative treatments are failing or your symptoms are too severe to wait then surgery may be advised.

A decompression is also known as: laminectomy. It is performed under general anaesthetic and the surgery takes between 1 and 3 hours depending on the number of levels that need to be decompressed. This is a commonly performed surgical procedure which is performed from the back with the patient lying on their front. The skin and underlying muscles are cut to expose the back of the spine. Variable amounts of bone and ligament are removed until a big enough window is achieved to decompress the dural sac and nerve roots. You will be in hospital for 1-5 days after surgery. Postoperatively you will need physiotherapy and have exercises to do on your own. The wound will take 2 weeks to heal but absorbable sutures are used so there are no clips or sutures to remove. You should be able to return to work between 2 weeks to 2 months depending on your activity.