Spinal stenosis means the canal that carries your spinal cord and nerves has become narrow, usually from age-related changes, and the squeezed nerves cause pain, numbness or weakness. Many people manage well with exercise, medicines and physiotherapy, and surgery is usually only considered when symptoms keep limiting your walking or daily life, or when there are signs of nerve or spinal cord damage.
For patients in Lahore and their families, the usual questions are whether it will get worse, whether an older person can safely have an operation, and how long recovery takes. This page covers both lumbar (lower back) and cervical (neck) stenosis.
The spine has a central tunnel for the spinal cord and smaller side openings where nerve roots leave. Over the years, discs lose height and bulge, the small facet joints enlarge with arthritis, and a ligament at the back of the canal (the ligamentum flavum) thickens. Together these changes slowly reduce the space for the nerves.
Stenosis is most common in the lower back (lumbar stenosis), where it affects the nerves to the legs. It also occurs in the neck (cervical stenosis), where it can press on the spinal cord itself. The two behave quite differently, so they are described separately below.
The classic symptom is called neurogenic claudication. In plain words, your legs become heavy, aching, numb or weak when you stand or walk, and the discomfort eases when you sit down or bend forward.
Leg pain from stenosis can be confused with poor circulation in the legs. A key difference is that circulation pain usually settles just by standing still, while stenosis pain usually needs sitting or bending forward.
When the narrowing is in the neck, the spinal cord can be compressed. This is called cervical myelopathy, and it often develops slowly and painlessly, so it is easy to miss.
Cervical stenosis often develops from wear-and-tear in the neck, described in more detail on our page on cervical spondylosis.
Go to an emergency department straight away if you develop new loss of bladder or bowel control, numbness around the back passage or genitals, or rapidly worsening weakness in the legs. These can be signs of severe nerve compression (cauda equina syndrome) and need same-day assessment. With neck stenosis, quickly worsening hand weakness, frequent falls, or new difficulty walking should also be seen urgently.
Diagnosis begins with your story and an examination. Dr. Khawar Anwar will ask how far you can walk, what relieves your symptoms, and whether you have noticed hand clumsiness or balance problems. He will check strength, sensation, reflexes and walking.
Many older people have some narrowing on MRI without symptoms. Treatment is based on your symptoms matching the scan, not the scan alone.
Most people with mild or moderate lumbar stenosis start with non-surgical care, and many find their symptoms become manageable.
Cervical myelopathy is different. Because spinal cord damage may not fully recover, non-surgical care is usually reserved for very mild cases with close follow-up, and surgery is often advised once the cord is clearly affected.
The aim of stenosis surgery is decompression: removing the bone, thickened ligament or disc material that is pressing on the nerves. The right approach depends on where the narrowing is and whether the spine is stable.
For suitable lumbar stenosis at one or two levels, endoscopic spine surgery allows the surgeon to remove the thickened ligament and bone through a small incision using a camera. It usually disturbs less muscle, but it is not suitable for every pattern of stenosis.
A laminotomy removes part of the bony roof (lamina) over the nerves; a laminectomy removes more of it. Both remain standard operations, especially when several levels are narrow.
If the vertebrae are slipping or moving abnormally, simply decompressing may leave the spine unstable. In that case, screws and rods are added and the bones are encouraged to fuse together. This is most common when stenosis occurs with spondylolisthesis.
For the neck, surgery may be done from the front (removing discs and bone spurs, then fusing) or from the back (laminoplasty or laminectomy, sometimes with fixation). The choice depends on how many levels are involved and the shape of the neck.
You can read about the wider range of procedures on our spine surgery page.
Most stenosis patients are older, and age alone is not a reason to avoid surgery. What matters more is general health: heart and lung condition, diabetes control, blood thinners and bone strength. These are checked before surgery.
After cervical myelopathy surgery, the main goal is to stop further cord damage. Some improvement in hand function and balance is common, but recovery can be partial, which is why earlier treatment is preferred.
Possible risks include infection, bleeding, a tear in the nerve lining (dural tear) causing a fluid leak, nerve injury, blood clots, and persistent or recurrent symptoms. Stenosis can also develop at other levels over time. Older patients have additional general risks related to anaesthesia, which are discussed openly before any decision.
Lumbar stenosis often stays stable or changes slowly over years, and many patients never need an operation. Cervical stenosis with spinal cord signs is more likely to progress, so it needs closer monitoring and often surgery.
Many older patients have decompression surgery safely. The decision depends on overall health rather than age alone, and less invasive options such as endoscopic decompression may be suitable for some.
Not always. Many patients need decompression only. Fusion is usually added when X-rays show the vertebrae slipping or moving abnormally, as in some cases of spondylolisthesis.
Walking distance often improves once the nerves are freed, but results vary, and long-standing numbness may improve less than pain.
Bring your MRI, X-rays and a list of your medicines. You can book an appointment for a consultation to discuss whether non-surgical care or surgery suits you.
Dr. Khawar Anwar is a Consultant Neurosurgeon & Spine Surgeon at PINS / Lahore General Hospital, Lahore, with over 10 years of experience in brain and spine surgery. He sees patients in Lahore and Gujranwala and focuses on minimally invasive and endoscopic techniques where they are suitable for the patient.
See the full list on the certifications page or read more about Dr. Khawar Anwar.
See all clinics, maps and timings on the locations page.
To book, call or WhatsApp 0333-7574732 and tell us which clinic and day suits you. Please bring your MRI or CT scan (films and CD), reports and a list of your current medicines to the consultation. For sudden weakness, loss of bladder or bowel control, a sudden severe headache or a head or spine injury, go to the nearest emergency department first.