Lumbar Spinal Stenosis Treatment in Delhi

Lumbar spinal stenosis is narrowing of the space in the lower spine through which the nerves travel. It is usually a consequence of ordinary ageing — discs lose height, the small facet joints enlarge, and the ligament inside the canal thickens. Together these gradually reduce the room available to the nerves.

It is the most common reason people over 60 have spinal surgery. It is also frequently misdiagnosed as a circulation problem or simply as “getting older,” because the pattern of symptoms is distinctive and easily missed.

The characteristic complaint is not back pain. It is leg pain, heaviness, aching or cramping that comes on when you walk and eases when you sit down or bend forward. Doctors call this neurogenic claudication.

Patients describe it in consistent ways: walking distance shrinking over months or years; needing to stop and rest; leaning on a shopping trolley being easier than walking upright; finding that going uphill is easier than going downhill; being fine on a bicycle but not on foot.

The reason is mechanical. Bending forward slightly opens the spinal canal and gives the nerves more room. Standing upright and extending the spine closes it down.

That last detail is also how it is distinguished from poor circulation in the legs, which produces similar pain on walking but is not relieved by changing posture, and which is not eased by leaning forward. The distinction matters because the treatments are entirely different, and both conditions are common in the same age group — some patients have both.

Diagnosis is clinical first: your account of what happens when you walk, and examination of sensation, power and reflexes. An MRI confirms where and how severely the canal is narrowed, and standing X-rays show whether there is any instability or slip between vertebrae.

Imaging alone is not enough. Narrowing shows up on the scans of plenty of people who walk perfectly well. It is the combination of the scan and your symptoms that makes the diagnosis, and it is the reason we will spend time asking exactly how far you can walk and what makes it better.

Where the leg pain could be coming from more than one level, an image-guided nerve root block can help identify which one is responsible before any operation is planned.

Stenosis does not usually get worse quickly, and many people manage well for years without an operation. Reasonable first steps are:

• Physiotherapy — targeted strengthening and flexion-based exercise, which is generally better tolerated than extension
• Staying active within your walking limit, and using a bicycle or exercise bike, which most patients tolerate far better than walking
• Medication for pain
• Weight management where relevant, which reduces the load on the lower spine

We should be honest about epidural steroid injection here. It can give some patients a useful window of relief, but the published evidence does not support it as a treatment for the walking limitation of central stenosis, and it does not reduce the likelihood of eventually needing surgery. We would not offer it as a substitute for a decision.

Where walking distance has become genuinely limiting and non-surgical measures have not helped, decompression is the operation that addresses it. The principle is simple: remove the thickened ligament and trim the overgrown bone that are crowding the nerves, making room without destabilising the spine.

Done through a small working channel, this can often be achieved from one side only, decompressing both sides — a technique called unilateral laminotomy for bilateral decompression. Working from one side spares the muscles, ligaments and joint structures on the other, which helps preserve stability.

Most patients notice the walking distance improve first, often quite quickly. Back pain responds less predictably than leg symptoms — decompression is an operation for the nerves, not for a worn-out disc.

Where there is significant instability or a slip between vertebrae, decompression alone may not be enough and a minimally invasive fusion may be discussed instead. That is a bigger decision and we would not rush it.

Where stenosis is severe at several levels and symptoms affect both legs, decompressing one level selectively carries a meaningfully higher chance of needing a further procedure later — in one published series, about one in ten patients within the follow-up period.

There is a genuine trade-off here, not a right answer. A smaller, targeted operation means an easier recovery but a higher chance of returning. A wider decompression is more definitive but more disruptive. Which suits you depends on your age, your general health, how many levels are involved and what you need to be able to do.

We will set out both options rather than presenting the smaller one as obviously better.

Decompression for stenosis is usually a shorter stay than a fusion, but it is not always a day case — pooled data on endoscopic stenosis decompression show an average stay of a little over two days. Walking begins the same day. Most patients are back to light activity within a few weeks, with physiotherapy guiding the pace.

Risks include dural tear, infection, nerve injury, bleeding and epidural haematoma, and incomplete relief of symptoms. Endoscopic techniques carry some risks open surgery does not, related to the irrigation fluid used. Where a wider decompression is needed, there is a small risk of creating instability that later requires fusion.

Numbness and weakness that have been present a long time may not fully recover, whatever is done. Nerves that have been compressed for years do not always return to normal, and it is better to know that before surgery than to discover it after.

What does spinal stenosis feel like?

The typical pattern is leg pain, heaviness, aching or cramping that comes on when you walk and settles when you sit down or lean forward. Walking distance shrinks over months or years. Many patients find leaning on a trolley easier than walking upright, and cycling easier than walking. Back pain may be mild or absent — it is the leg symptoms on walking that point to stenosis.

Why is it easier to walk leaning forward?

Bending forward slightly opens up the spinal canal and gives the compressed nerves more room, while standing upright closes it down. This is also how spinal stenosis is distinguished from poor circulation in the legs, which causes similar pain on walking but is not relieved by changing posture.

Does spinal stenosis always need surgery?

No. Stenosis usually progresses slowly and many people manage for years with physiotherapy, staying active within their limit, cycling rather than walking, and pain relief. Surgery is considered when the walking limitation has become genuinely restricting and non-surgical treatment has not helped. It is a quality-of-life decision rather than an urgent one, unless there is progressive weakness or loss of bladder or bowel control.

Will decompression cure my back pain?

Not reliably. Decompression is an operation for the nerves, so it works best on the leg symptoms and the walking limitation. Back pain from worn discs and joints responds much less predictably. We would rather set that expectation clearly beforehand, because patients who expect their back pain to disappear are often disappointed even when the operation has done exactly what it was meant to.

Might I need a second operation?

Possibly. Where stenosis is severe at several levels and both legs are affected, decompressing one level selectively carries a higher chance of needing further surgery later — around one in ten in one published series. A wider decompression is more definitive but more disruptive. We will go through that trade-off with your scan rather than assume which you would prefer.

Spinal stenosis is assessed and treated by Dr. Om Prakash Gupta, Senior Consultant Orthopaedic & Endoscopic Spine Surgeon, as part of Sama’s Minimally Invasive & Endoscopic Spine Surgery service.

Sama Hospital, 8 Siri Fort Road, Sadiq Nagar, New Delhi 110049. 24/7 emergency; specialist OPD during daytime hours. For an estimate of cost, call us — please bring your MRI films.