Lumbar Spinal Stenosis

Lumbar spinal stenosis is most commonly caused by age-related degeneration of the spinal structures. As the spine ages, multiple changes occur simultaneously that collectively reduce the space available for the spinal nerves and cauda equina:

• Facet joint arthritis and hypertrophy — the small joints at the back of each spinal level enlarge with arthritis, encroaching on the nerve channels
• Ligamentum flavum thickening and buckling — the ligament lining the back of the spinal canal becomes thickened and infolded, compressing the nerves from behind
• Intervertebral disc bulging and collapse — degenerate discs lose height and bulge into the spinal canal, contributing to central narrowing
• Osteophyte formation — bony spurs grow from the edges of vertebral bodies and facet joints, further reducing available space
• Spondylolisthesis — slipping of one vertebra on another narrows the canal and foramen at the affected level

Less commonly, stenosis can be congenitally narrow (present from birth), meaning even modest degenerative changes produce symptomatic compression at a younger age. Rarer causes include spinal tumours, epidural lipomatosis, and post-surgical scarring. At One Brain and Spine, our neurosurgeons assess the precise anatomical contributions to each individual patient's stenosis to guide the most appropriate treatment.

Symptoms of lumbar spinal stenosis depend on the degree and level of canal narrowing, whether central canal or lateral foraminal compression (or both) is present, and individual patient factors.

Neurogenic Claudication

The classic symptom of lumbar canal stenosis is neurogenic claudication — pain, cramping, heaviness, or weakness in the legs (particularly the buttocks, thighs, and calves) that is provoked by walking or prolonged standing, and relieved by sitting, squatting, or flexing the lumbar spine forward. Patients often describe being able to walk only a limited distance before needing to stop and rest. Shopping trolleys, bicycle riding, and walking uphill (which flexes the spine) are typically better tolerated than walking on flat ground or downhill.

Leg Pain and Radiculopathy

Foraminal stenosis — narrowing of the exit channels for individual nerve roots — can produce radicular leg pain (sciatica), numbness, tingling, and weakness in the distribution of the compressed nerve root. This can occur alongside neurogenic claudication or in isolation.

Back Pain

Chronic lower back pain is common in patients with lumbar spinal stenosis and is often related to concurrent facet joint arthritis, degenerative disc disease, or spondylolisthesis at the affected levels.

Red Flag Symptoms — Seek Urgent Medical Attention

Attend your nearest emergency department immediately if you experience any of the following — these may indicate cauda equina syndrome, a neurosurgical emergency:

• Sudden or rapidly progressive weakness in both legs
• Loss of bladder control — urinary retention or incontinence
• Loss of bowel control
• Numbness in the saddle region — inner thighs, perineum, and buttocks

Diagnosis is based on a combination of clinical assessment and targeted imaging. At One Brain and Spine, our Melbourne neurosurgeons conduct a thorough evaluation to confirm the diagnosis, identify the levels involved, and determine the most appropriate treatment.

Clinical Assessment

Your neurosurgeon will take a detailed history focusing on the pattern of your leg pain in relation to walking and posture, and perform a comprehensive neurological examination. The characteristic history of neurogenic claudication is often the most important diagnostic feature — imaging alone is insufficient as canal narrowing is common in asymptomatic individuals.

Imaging Investigations

• MRI — the gold standard investigation for lumbar spinal stenosis, demonstrating canal diameter, nerve compression, disc and facet joint pathology, and the presence of spondylolisthesis
• CT Scan — provides excellent bony detail and is useful when MRI is contraindicated or to plan surgical decompression
• X-ray (including dynamic flexion/extension views) — assesses spinal alignment and detects spondylolisthesis or segmental instability
• CT Myelogram — used in selected cases, particularly those with prior spinal surgery
• Bone scan (including SPECT CT) — can identify active facet joint arthritis and active disc degeneration, helping to target treatment

Imaging findings must always be correlated with clinical symptoms. Canal narrowing is common on MRI in asymptomatic older adults — treatment decisions at One Brain and Spine are based on the complete clinical picture.

Non-Surgical Treatment Options

Many patients with lumbar spinal stenosis can be managed effectively with non-surgical treatment, particularly those with mild to moderate symptoms. Research supports conservative management as the first line of treatment in the absence of significant neurological compromise.

Non-surgical treatment options available in Melbourne include:

• Activity modification — choosing activities that flex the spine (cycling, swimming) and avoiding aggravating activities such as prolonged standing or walking downhill
• Analgesic and anti-inflammatory medications — to manage pain and reduce nerve inflammation
• Neuropathic pain medications — such as gabapentin or pregabalin for nerve-related leg symptoms
• Physiotherapy — targeted exercises focusing on lumbar flexion, core strengthening, and postural training
• Epidural steroid injections — corticosteroid injected into the epidural space to reduce nerve inflammation and provide symptomatic relief
• Facet joint injections — targeted injections for concurrent facet joint arthritis contributing to back pain
• Walking aids — a walking frame or shopping trolley encourages a slightly flexed posture, which can significantly improve walking tolerance
• Weight management and general fitness — reducing BMI decreases mechanical load on the stenotic segments

When is Surgery Required for Lumbar Spinal Stenosis?

Surgery for lumbar spinal stenosis is considered when symptoms are severe or significantly limiting quality of life, when conservative treatment has failed to provide adequate relief, or when there is progressive neurological deficit. The evidence strongly supports surgical decompression for appropriately selected patients — over 80% of patients report good to excellent outcomes following surgery for lumbar spinal stenosis.

Surgical indications include:

• Neurogenic claudication severely limiting walking distance or daily activities despite adequate conservative management
• Progressive leg weakness or neurological deterioration
• Significant reduction in quality of life — inability to work, exercise, or maintain independence
• Cauda equina syndrome — absolute surgical emergency requiring urgent decompression

Surgical Treatment Options

At One Brain and Spine, our Melbourne neurosurgeons offer the full range of surgical options for lumbar spinal stenosis, tailored to the specific anatomy and needs of each patient.

H3 Minimally Invasive Lumbar Decompression (MILD / MIS Laminectomy)

For selected patients with focal stenosis and without significant instability, a minimally invasive decompression can be performed through small incisions using tubular retractors and microscopic magnification. This removes the compressing bone and ligament with minimal disruption to the surrounding muscles, resulting in less post-operative pain and faster recovery.

Endoscopic Laminectomy

The decompression performed using the endoscopic and specific endoscopic spinal instruments through one or two very small incisions.  Visualisation is with the endoscope at the spine itself with extremely high levels of clarity using the 4K HD scopes.  The laminectomy is performed using a high speed drill to undercut the bones of the lamina and spinous process, allowing removal of the offending ligamentum, disc and bone spurs as required.  This is a sub-specialised approach offered at One Brain and Spine, affording a quicker recovery with decreased risks for the patient.

Laminectomy

A standard laminectomy involves removal of the lamina (the bony roof of the spinal canal) at the affected levels to create more space for the compressed nerves. This is an established and highly effective procedure for lumbar spinal stenosis, with over 80% of appropriately selected patients achieving good to excellent outcomes.

H3 Decompression with Spinal Fusion

When spinal stenosis is accompanied by significant spondylolisthesis, spinal instability, or when the degree of decompression required is likely to destabilise the spine, a spinal fusion is performed in addition to the decompression. Fusion stabilises the affected segment, prevents further slipping, and can substantially reduce associated back pain. Minimally invasive fusion techniques — including TLIF, ALIF, PLIF, and XLIF — are available at One Brain and Spine.

Recovery and Prognosis

Recovery depends on the extent of surgery and individual patient factors. General milestones for most patients:

• Leg pain and claudication symptoms — often improve significantly within days to weeks of surgery
• Hospital stay — typically 1–3 nights depending on the procedure
• Mobilisation — patients are encouraged to walk from the day after surgery
• Return to sedentary work — usually 2–4 weeks
• Return to physical activity — typically 6–12 weeks
• Back pain — may take longer to resolve than leg symptoms

Risks and Complications

As with any spinal surgery, decompression for lumbar stenosis carries a small risk of complications, which will be discussed in detail with your neurosurgeon at One Brain and Spine prior to proceeding:

• Dural tear (CSF leak) — occurs in approximately 3–5% of cases; usually managed at the time of surgery
• Infection — superficial wound infection or, rarely, deep infection
• Nerve injury — rare, may result in persistent numbness or weakness
• Incomplete symptom relief — more likely when nerve compression has been prolonged
• Recurrent stenosis — degenerative changes can recur over time
• Spinal instability — may require subsequent fusion if not addressed at initial surgery
• Anaesthetic risks — discussed with your anaesthetist