Lumbar spinal stenosis
Narrowing of the spinal canal — Neurogenic claudication
SFCR Patient Sheet: Download the patient information leaflet (PDF)
What is lumbar spinal stenosis?
The nerves of the lumbar spine travel through a bony tunnel called the spinal canal. Over time, arthritis, ligament thickening and disc bulging can progressively narrow this canal, squeezing the nerve roots within: this is lumbar stenosis, or spinal canal narrowing.
It is the leading cause of spinal surgery after the age of 65. The process is slow and insidious: patients often only realise what is happening the day they notice they can no longer walk as far as they used to, forced to stop and lean forward to relieve the compression.
How it develops
The narrowing results from the progressive degeneration of several structures:
• Facet joint arthritis: the posterior joints thicken and "overflow" into the canal
• Ligamentum flavum hypertrophy: this normally thin, supple ligament becomes thick and "buckled", reducing the available space
• Disc bulging: worn discs protrude backwards, adding to the compression
• Spondylolisthesis: a vertebral slip can worsen the stenosis by creating a step-off in the canal
Symptoms & Clinical signs
The hallmark sign is neurogenic claudication — a highly recognisable pattern:
• Reduced walking distance: the patient can walk a certain distance (500 m, 200 m, sometimes just 50 m) then must stop because of pain, heaviness or tingling in the legs
• Shopping trolley sign: leaning forward (over a shopping trolley, a bicycle, a railing) brings immediate relief because this position "opens" the canal
• Difficulty going downhill: standing upright or walking downhill worsens symptoms (the canal closes in extension)
• Cramping and tingling: a feeling of "heavy", "cottony" or "giving way" legs after a period of walking
• Low back pain: often associated, but it is the difficulty walking that dominates the picture
Diagnosis
• Clinical examination: paradoxically often "normal" at rest; it is the patient's story (walking distance, relief when leaning forward) that points to the diagnosis
• Lumbar MRI (gold standard): shows the canal narrowing, its level and extent
• CT scan: complementary, it details bony structures (arthritis, osteophytes) with great precision
• EMG: sometimes useful to assess the impact on the nerves, particularly if peripheral neuropathy is suspected
Treatment
Lumbar spinal stenosis does not resolve on its own — the narrowing does not regress — but symptoms can be managed:
Conservative treatment
• Flexion-based physiotherapy ("curling" exercises) to open the canal
• Painkillers and anti-inflammatory drugs for pain flare-ups
• Epidural injections: can provide temporary relief by reducing inflammation around the compressed nerves
• Lifestyle adaptation: cycling rather than long walks, avoiding positions in extension
Surgical treatment (decompression laminectomy)
• Indications: significantly reduced walking distance despite medical treatment, with impact on quality of life
• Technique: "laminectomy" involves removing the bone and ligaments that are crushing the nerves, restoring the space they need
• Outcome: significant improvement in walking ability in over 80% of cases; patients often regain a walking distance they had lost years ago
Key figures
Leading cause
Of spinal surgery after the age of 65
80%
Improvement in walking ability after decompression surgery
500 m
Walking distance threshold often cited as a measure of functional impact
Recovery after surgery
After a decompression laminectomy performed by Dr Dimitriu:
• Day of surgery: getting up is encouraged the same evening. Patients often notice an immediate improvement in walking
• Hospital stay: 2 to 4 days on average
• First weeks: progressive daily walking, increasing distances each day. Avoid heavy lifting and prolonged sitting
• 6 weeks: lumbar muscle strengthening physiotherapy resumes. Gradual return to daily activities
• 3 months: most patients have regained a satisfactory walking distance and can resume gentle sport (long walks, cycling, swimming)
• Time off work: 4 to 8 weeks depending on occupation
Consultation with Dr Dimitriu
Dr Dimitriu places great importance on listening to the patient: walking distance, impact on daily life and expectations are at the heart of the treatment decision. The clinical examination looks for the characteristic signs of stenosis and rules out other causes of walking difficulty (arterial disease, neuropathy).
MRI analysis determines the number of affected levels, the degree of compression and whether additional stabilisation (fusion) is needed in cases of associated spondylolisthesis. Dr Dimitriu offers a clear, tailored treatment plan for your situation.
Consultations in Île-de-France
Dr Dimitriu practises at 4 facilities in the Paris region (Île-de-France), easily accessible from central Paris: Clinique de l'Yvette (Longjumeau), Hôpital Privé d'Antony, Clinique du Mont-Louis (Les Lilas) and Hôpital Privé de l'Ouest Parisien (Saint-Cloud). See addresses and book an appointment.
Frequently asked questions
Surgery is considered when walking distance is significantly reduced despite well-conducted medical treatment and quality of life is affected. Dr Dimitriu assesses the benefit-risk ratio with each patient based on age, general health and severity of the stenosis.
Laminectomy is a common, well-established procedure. The main risks (infection, haematoma, nerve injury) are rare, in the range of 1 to 2%. The satisfaction rate exceeds 80%. Dr Dimitriu uses minimally invasive techniques where possible.
Yes, getting up is encouraged on the same day or the day after. Most patients notice improved walking ability from the very first steps. The hospital stay averages 2 to 4 days.
Recurrence at the same level is rare. However, stenosis can develop at an adjacent level over the years. Core strengthening and regular physical activity are the best means of prevention.
Sources: SFCR · NEJM (Weinstein et al., SPORT Trial) · HAS.