Before discussing spinal stenosis treatment, let us answer the question: what is spinal stenosis? The spinal cord and the nerves that branch from it lie inside a canal we call the spinal canal. With age and after trauma, the facet joints and discs surrounding the spinal canal wear out and arthritis then develops. This process gradually begins to narrow the spinal canal, causing the spinal cord and the nerves to become compressed inside it.
Although its main cause is advancing age, spinal stenosis can also be seen in younger patients who do physical work and carry heavy loads. The disease progresses over the years. The typical complaint is weakness and numbness in the legs that starts with walking (neurogenic claudication): after walking a certain distance, patients need to rest.
In advanced cases (walking distance below 100 metres, urinary incontinence) surgery is absolutely necessary. In spinal stenosis treatment, conservative treatments and interventional pain methods are used in cases that have not progressed. Because the disease tends to progress, the boundary between these treatments and surgery must be defined very carefully. In patients with spinal stenosis who need surgery, a delayed operation can lead to irreversible problems (permanent weakness in the legs, urinary incontinence).
CONSERVATIVE TREATMENTS
They are applied in patients who do not yet require surgery and comprise the first-line treatments used in spinal stenosis treatment: medication, weight loss, physiotherapy, and patient education about what to do and what to avoid for a healthy spine.
INTERVENTIONAL PAIN TREATMENTS
Interventional pain techniques are used in patients who do not improve with conservative methods, or in combination with them. Lumbar spinal stenosis is a chronic process, and the right approach is to carry out all treatments together. At our clinic we use lumbar epidural injection techniques as the interventional pain treatment for spinal stenosis. Patients with pain caused by lumbar facet joint arthritis (facet syndrome) receive facet denervation in the same session. (lumbar facet joint treatment)
SURGICAL METHODS
Our surgical team successfully performs the closed spinal stenosis operation (microlumbar laminectomy), which has become popular worldwide in recent years. For detailed information and our three-dimensional animation video, please click.
Appointments & practical information
How do I book an appointment?
You can send your appointment request via WhatsApp, by phone or through the contact form. Briefly describing your complaint and the times that suit you speeds things up; we respond as quickly as possible.
What should you bring to the consultation?
If available, bring your recent MRI and CT images, previous test and surgery reports, and a list of the medication you take regularly. This makes the assessment considerably easier.
What happens at the first consultation?
We listen to your complaints and history, perform a neurological examination and review your existing images together. Treatment options are then planned with you, taking your expectations and lifestyle into account.
Second opinion
If you have been diagnosed or advised to have surgery elsewhere, you can book an appointment for a second opinion with your existing images and reports.
Reach out for your questions and appointment requests. We reply as soon as possible.
Spinal stenosis, popularly known as spinal canal narrowing, is a condition in which the bony canal through which the spinal cord and nerve roots pass narrows due to aging or other factors. As a result of this narrowing, the nerves become compressed and the conduction to the legs is impaired. It usually occurs in the lower back region (Lumbar Stenosis) and is a chronic process that seriously restricts the patient's quality of life.
What Are the Symptoms of Spinal Canal Narrowing (Spinal Stenosis)?
The most typical symptom is what we call "Neurogenic Claudication" — a feeling of numbness, cramping, and fatigue in the legs that occurs while walking. After walking a certain distance, the patient needs to stop and rest. In addition, there is lower back and hip pain, a burning sensation in the legs, and in advanced cases, loss of urinary/bowel control and permanent loss of strength in the legs.
What Causes Spinal Canal Narrowing (Spinal Stenosis)?
The most common cause is degeneration related to aging. It occurs as a result of the discs between the vertebrae losing water and collapsing, the joints thickening due to calcification, and the ligaments within the spine (ligamentum flavum) losing their elasticity and thickening, thereby narrowing the canal. Rarely, a congenitally narrow canal structure or previous traumas can also lead to this condition.
What Happens If Spinal Canal Narrowing (Spinal Stenosis) Is Left Untreated?
Untreated canal narrowing is unfortunately not a process that heals on its own; on the contrary, it is progressive. Over time, the patient's walking distance can decrease to just a few meters. Chronic pressure on the nerves can cause the leg muscles to waste away, lead to permanent numbness, and result in the patient becoming bedridden.
What Is the Treatment for Spinal Canal Narrowing (Spinal Stenosis)?
Treatment is planned according to the stage of the disease. At the initial level, medication, rest, and physical therapy are applied. In moderate narrowing, the area around the nerve is relieved with epidural injections and nerve blocks. However, in advanced narrowing and in the presence of neurological loss, surgical intervention (decompression) is the definitive solution.
How Is Spinal Canal Narrowing (Spinal Stenosis) Diagnosed?
The diagnostic process begins with a detailed history and examination that inquires about the patient's walking distance. For a definitive diagnosis, a lumbar MRI is the gold standard; the diameter of the canal is measured in millimeters. To see the calcifications in the bony structure more clearly, Computed Tomography (CT) is used, and an EMG test to check the conduction status of the nerves also assists in the diagnosis.
How Effective Are Non-Surgical Treatment Methods (Epidural Injection, Nerve Block) in Spinal Canal Narrowing?
Non-surgical methods are quite effective, especially in "mild and moderate" degrees of narrowing. Epidural injections reduce the inflammation in the nerve roots, relieving the patient's pain and can significantly increase the walking distance. However, if the canal is completely closed off by bone and ligament tissue, these methods only provide temporary relief; the permanent solution is surgery.
At Which Stage of Spinal Canal Narrowing Is Surgery Needed?
If the patient's walking distance has dropped below 100-200 meters, if a significant loss of strength has begun in the legs, and if no results are being obtained from the applied injection treatments, then the time for surgical intervention has come. When making the decision, the amount of restriction in the patient's daily life is taken into account rather than the MRI image.
In Spinal Canal Narrowing Surgery, When Is It Necessary to Place Metal Plates (Screws)?
It is not essential to place screws in every canal narrowing surgery. Screw treatment is applied to preserve the balance of the spine in cases of slippage in the spine (spondylolisthesis), curvature (scoliosis), or when a large amount of bone tissue needs to be removed to relieve the canal during surgery. In a stable spine, simply widening the canal (decompression) may be sufficient.
What Are the Risks of Spinal Canal Stenosis Surgery?
Thanks to modern microsurgical techniques and neuromonitoring devices, the risks have been considerably minimized. However, as with any surgery, infection, bleeding, or rarely a tear in the dura (the membrane covering the spinal cord) may occur. With an experienced surgeon and the right technique, these risks are managed successfully.
Why Do I Have to Stop While Walking?
The reason for this is "neurogenic claudication." As you walk, the nerves in your legs need more blood flow and oxygen. However, the narrowed canal does not allow for this need; the nerves become compressed and a sensation of "blockage" develops in your legs. Stopping and bending forward or sitting down relieves you, because it temporarily widens the diameter of the canal.
What Is the Difference Between a Lumbar Disc Herniation and Canal Stenosis?
A lumbar disc herniation usually begins suddenly and involves soft disc tissue compressing the nerve; it can occur at any age. Canal stenosis, on the other hand, is a chronic process spread over years, usually seen in people over the age of 50, caused by the thickening of bone and ligament tissue. While a herniation can cause pain even at rest, the pain of canal stenosis typically increases with walking.
Does Spinal Canal Stenosis Cause Burning and Numbness in the Legs?
Yes, it absolutely does. Chronic pressure on the nerves leads to sensations such as burning, numbness, or an "electric shock" feeling in the legs, buttocks, and soles of the feet. This condition is a sign that nerve damage has begun.
Is Surgery Always Necessary for Spinal Canal Stenosis?
Not every patient with canal stenosis has to undergo surgery. If your complaints do not greatly impair your quality of life and you have no neurological deficit, you can continue your life with weight control, exercise, and periodic injection treatments. Surgery is a lifesaver "when the end of the road has been reached" and life has become unbearable.
Can an Epidural Injection Be a Solution for Spinal Canal Stenosis?
The epidural injection is the most powerful weapon before surgery. In a large proportion of patients with canal stenosis, it can relieve the pressure and edema around the nerve, providing relief that lasts for months, sometimes years. Even if it does not cure the condition completely, it is a very successful method for delaying surgery or improving quality of life.
Does Spinal Canal Stenosis Cause Paralysis?
Because canal stenosis is usually a slowly progressing process, the risk of sudden paralysis is lower than with a lumbar disc herniation. However, in neglected cases where the loss of strength in the legs is not taken seriously, nerve conduction can be completely cut off and irreversible gait disorders may develop. Early diagnosis and proper follow-up eliminate the risk of paralysis entirely.
Is Nucleoplasty Beneficial for Spinal Canal Stenosis?
Nucleoplasty is more of a treatment focused on "lumbar disc herniation." In canal stenosis, the main problem is not the disc tissue but the thickening of bone and ligament tissue. For this reason, unless there is an accompanying large herniation, nucleoplasty is not the first choice in the treatment of canal stenosis. In these cases, epidural injections provide far superior success.
How Is Closed Canal Stenosis Surgery Performed?
The method referred to as "closed" in modern medicine is actually the microsurgical technique. In this procedure, access is gained through a very small incision of about 2-2.5 cm in the lower back region. Using a high-resolution surgical microscope, the thickened ligament tissue (ligamentum flavum) and bony protrusions that are compressing the nerves are cleared away millimeter by millimeter. Because the natural supporting structures of the spine are not damaged, bleeding is minimal and the recovery process is very fast.
What Are the Closed Surgical Methods for Canal Stenosis?
The most common and reliable method is "decompression by microsurgery." In addition, in suitable cases, fully closed (endoscopic) methods can also be preferred. The main goal is to widen the canal through which the nerves pass with the least possible damage, without disrupting the stability (soundness) of the spine. Unlike classic open surgeries, these methods do not involve large muscle incisions or extensive bone removal.
What Is the Success Rate of Surgery for Spinal Canal Stenosis?
With the right patient selection and meticulous microsurgical planning, the success rate in canal stenosis surgeries is over 90%. Most of our patients report that they are freed from the "inability to walk" and "heaviness in the legs" complaints they experienced before surgery, and that their walking distance has increased dramatically.
Can Nerve Damage Occur During Spinal Canal Stenosis Surgery?
Thanks to advanced microscope technology and devices called "neuromonitoring" that continuously track nerve functions in real time during the procedure, the risk of nerve damage has dropped below 1%. The combination of the surgeon's experience and these technologies makes the operation extremely safe.
How Many Days After Spinal Canal Stenosis Surgery Can I Get Up on My Feet?
The biggest advantage of the closed/microsurgical method is that it mobilizes the patient quickly. Our patients can generally get up on their feet and walk in the corridor accompanied by a nurse and physiotherapist about 4-6 hours after surgery, as soon as the effect of the anesthesia wears off. The hospital stay is usually just one night.
Will My Spinal Canal Stenosis Complaints Disappear Immediately After Surgery?
The leg pain and cramps that occur while walking usually disappear the very day after surgery. However, the complete resolution of the numbness and tingling sensation caused by long-term pressure may take a few weeks or months, depending on how quickly the nerve regenerates. The moment the pressure on the nerve is relieved, the "healing clock" begins to tick.
Can I Bend Down and Get Up After Spinal Canal Stenosis Surgery?
During the first 4-6 weeks of the "tissue healing" process, sudden bending, twisting, and lifting heavy objects should be avoided. However, it is possible to squat down by bending the knees or to move in the way shown by the doctor. After the first month, as the back muscles get stronger, the patient fully regains normal daily mobility.
When Can I Return to Work After Spinal Canal Stenosis Surgery?
Our patients who work in desk-based and predominantly mental jobs can generally return to work within 10-15 days. In more active lines of work or those requiring physical strength, this period can extend to 4 to 6 weeks. Light walks done in the early period speed up the return-to-work process.
