Spinal Stenosis

Understanding Spinal Stenosis

Spinal stenosis is a disease of aging — the cumulative effect of decades of degenerative change in the spine. As intervertebral discs lose height and bulge, the ligamentum flavum hypertrophies and buckles, facet joints develop osteophytes, and the bony canal progressively narrows. In the lumbar spine, the cauda equina and traversing nerve roots become compressed within the narrowed canal, producing neurogenic claudication — pain, numbness, and weakness in the legs that is brought on by walking and relieved by sitting or forward flexion. In the cervical spine, the spinal cord itself is compressed, producing cervical myelopathy — a potentially irreversible condition characterised by gait disturbance, hand clumsiness, and sphincter dysfunction.

Early recognition and treatment are critical: while lumbar stenosis symptoms are reversible with decompression, cervical myelopathy may cause permanent spinal cord injury if not treated promptly. Istanbul's spine surgeons perform high-volume decompression procedures with outcomes comparable to leading international centres.

Symptoms of Spinal Stenosis

Lumbar spinal stenosis presents with neurogenic claudication: bilateral or asymmetric leg pain, heaviness, numbness, and weakness provoked by walking or standing and relieved by sitting, leaning forward, or lying down (the "shopping cart" sign — patients find relief by leaning on a shopping cart). Unlike vascular claudication, the symptoms are positional rather than based on a fixed walking distance, and pedal pulses are normal. Severe stenosis may produce radicular pain in a dermatomal distribution and, in advanced cases, cauda equina syndrome. Cervical stenosis presents with myelopathy: gait disturbance (broad-based, unsteady gait), hand clumsiness (difficulty with fine motor tasks such as buttoning), Lhermitte sign (electric shock sensation down the spine on neck flexion), and eventually spastic weakness and sphincter dysfunction.

Diagnostic Pathways

MRI of the spine is the definitive imaging modality, demonstrating the degree and level of central canal, lateral recess, and foraminal narrowing. The canal diameter is measured: lumbar stenosis is defined as a mid-sagittal diameter of under 12 mm (absolute stenosis under 10 mm). Cervical stenosis is defined as a canal diameter under 13 mm (absolute under 10 mm). CT myelography provides dynamic assessment of neural compression and is useful when MRI is contraindicated. Plain radiographs with flexion-extension views assess spinal alignment and stability, including the presence of degenerative spondylolisthesis. Electromyography and nerve conduction studies (EMG/NCS) help confirm the level of nerve root involvement and exclude peripheral neuropathy.

Advanced Treatment Options at Vellum Select

Spinal Decompression Surgery

For patients with moderate to severe symptoms that fail to respond to conservative management (physical therapy, analgesics, epidural steroid injections), Spinal Surgery in Turkey offers lumbar laminectomy and foraminotomy — decompression of the stenotic segments to create space for the neural elements. Minimally invasive approaches reduce muscle disruption and recovery time. When stenosis is accompanied by spondylolisthesis, decompression is combined with instrumented fusion to prevent post-laminectomy instability. Cervical stenosis is treated with anterior cervical discectomy and fusion (ACDF), cervical disc replacement, or posterior decompression and fusion depending on the pathology.

To discuss your spinal stenosis with a Vellum Select spine specialist, contact us to arrange a consultation.