Spinal Stenosis

Spinal stenosis is a condition in which the spaces within the spine, particularly the spinal canal, become narrowed, putting pressure on the spinal cord, and surrounding nerves. This pressure can cause pain, tingling, numbness or muscle weakness, often affecting the back, legs, arms or neck. The condition usually develops gradually, and is most common in older adults due to age-related wear and tear on the spine.

Spinal stenosis most often occurs in the lumbar (lower back), and cervical (neck) regions. While some individuals may have no symptoms, others may experience persistent discomfort, reduced mobility or difficulty walking that worsens over time.

What causes Spinal Stenosis?

As the spine undergoes gradual wear and tear, structural changes can narrow the spinal canal, and put pressure on surrounding nerves. However, age-related degeneration is not the only cause as other spinal conditions or injuries can also contribute to stenosis.

Some of the common causes include:

Degenerative disc disease – with age, the discs between the vertebrae begin to lose hydration, and height. As they shrink, they reduce the available space in the spinal canal, increasing the risk of nerve compression.
Herniated discs – when the inner gel-like material of a spinal disc bulges out or ruptures, it can compress nearby nerves, especially in areas where the spinal canal is already narrowed.
Osteoarthritis – this common form of arthritis leads to joint, and cartilage breakdown. As the spine reacts to this damage, bone spurs (osteophytes) may form, narrowing the spaces where nerves pass.
Spinal injuries – trauma from accidents, falls, or fractures can displace vertebrae or cause swelling and inflammation, further narrowing the spinal canal.
Thickened ligaments – ligaments that help stabilise the spine may stiffen, and thicken over time. This thickening can encroach upon the spinal canal, and press against the spinal cord or nerve roots.
Congenital spinal stenosis – some people are born with a naturally narrow spinal canal, which may lead to symptoms earlier in life or increase their vulnerability to stenosis as they age.

What are the symptoms of Spinal Stenosis?

Symptoms of Lumbar Spinal Stenosis (Lower Back)

Difficulty walking long distances.
Lower back pain, especially when standing or walking.
Loss of bladder or bowel control in severe cases (a medical emergency).
Numbness, tingling, or cramping in the legs or feet.
Pain that improves when sitting or bending forward (a classic sign).
Weakness in the lower limbs.

Symptoms of Cervical Spinal Stenosis (Neck)

Difficulty with bladder or bowel control (severe cases).
Neck pain or stiffness.
Problems with balance or coordination.
Tingling or numbness in the arms, hands or fingers.
Weakness in the arms or legs.

The difference between Spinal Stenosis and General Back Pain

Back pain is one of the most common health complaints, affecting people of all ages. While many cases are due to muscular strain or poor posture, others stem from more serious underlying conditions such as spinal stenosis. As such, recognising the differences between general back pain, and spinal stenosis is essential for appropriate diagnosis, and effective treatment.

FEATURE	SPINAL STENOSIS	BACK PAIN (GENERAL)
Definition	Narrowing of the spinal canal, compressing nerves or spinal cord.	Pain originating from muscles, ligaments, discs or joints.
Cause	Degenerative changes, arthritis, disc herniation, bone spurs.	Muscle strain, poor posture, injury, disc issues.
Onset	Gradual, progressive over time.	Sudden or gradual.
Pain Location	Lower back, radiating to buttocks or legs.	Can be localised or diffuse in the back.
Radiating Pain	Common – down the legs (sciatica-like symptoms).	Less common, and mostly localised.
Aggravating Factors	Standing, walking (especially downhill or extended periods).	Lifting, twisting, prolonged sitting or standing.
Relieving Factors	Sitting, leaning forward (shopping trolley sign).	Rest, heat, posture correction.
Numbness or Weakness	Often present in leg or feet.	Rare unless nerve involvement.
Balance or Gait Issues	May occur in advanced stages.	Rare.

Who is at risk of Spinal Stenosis in Singapore?

Spinal stenosis tends to affect older adults, but it can also occur in younger individuals depending on their spinal health, medical history, and lifestyle. In Singapore, people in the following groups may be at higher risk of developing spinal stenosis:

Age — ageing is the most significant risk factor, particularly adults who are 50 years old, and older. As spinal discs degenerate, and joints wear down with time, the spinal canal may narrow, increasing the likelihood of nerve compression, and related symptoms.
Gender — while spinal stenosis can affect both sexes, research suggests that men may be at slightly higher risk of developing certain types of spinal stenosis, particularly in the lumbar spine.
Family history of spinal problems — genetics play a role in how the spine ages, and responds to stress. Those with close relatives affected by spinal conditions may have a higher predisposition to stenosis.
History of spinal injury or surgery — past trauma, fractures or surgical interventions can alter spinal alignment or stability, leading to scar tissue formation or structural changes that predispose the spine to stenosis.
Arthritis — conditions like osteoarthritis, and rheumatoid arthritis can lead to joint inflammation, bone spur formation, and spinal degeneration, all of which contribute to spinal narrowing.
Congenital spinal abnormalities — those with a naturally narrow spinal canal are more vulnerable to developing symptoms earlier in life or as age-related changes set in.
Workers in physically demanding jobs — occupations that involve repetitive lifting, heavy manual labour or prolonged standing place repeated mechanical stress on the spine, accelerating wear, and increasing the risk of stenosis over time.

How is Spinal Stenosis diagnosed?

Diagnosing spinal stenosis requires more than simply identifying where symptoms occur. Since the condition often involves both mechanical narrowing and nerve compression, a careful and thorough assessment is essential to pinpoint the exact cause.

At Apicare Pain Clinic, we begin by understanding your symptoms in the context of your daily life by asking questions such as:

How they affect your mobility?
How they affect your sleep?
How they affect your ability to carry out routine activities?

Our doctors will then perform a focused evaluation to determine whether spinal nerves are involved and to guide personalised treatment and effective pain management.

Additionally, our diagnostic approach may also include:

Detailed history-taking — we explore when your symptoms began, how they have progressed, what triggers or relieves them, and whether there are signs of nerve involvement such as radiating leg pain, tingling or weakness. This helps differentiate spinal stenosis from other spine or nerve conditions.
Physical examination — this involves checking your posture, gait, and spinal range of motion, along with testing reflexes, sensation, and muscle strength. We look for signs of nerve root compression or spinal cord involvement, especially in the limbs.
Imaging studies:
- Computed Tomography (CT) Scans — CT scans may be used when Magnetic Resonance Imaging (MRI) is not feasible to get a clear picture of bone structures in complex or post-surgical cases.
- MRI Scans — MRI scans provide high-resolution images of the spinal canal, discs, and nerve roots. MRI is the preferred test to confirm nerve compression and assess its severity.
- X-rays — X-rays are helpful for detecting structural changes such as vertebral misalignment, bone spurs or narrowed disc spaces that may point to degenerative stenosis.

Image-guided diagnostic injections — we may perform targeted spinal injections (such as nerve root or facet joint blocks) under live imaging. If symptoms temporarily improve after the injection, it confirms the source of nerve irritation.
Functional assessments — for patients with ongoing or unclear symptoms, we assess how spinal stenosis impacts walking, balance, and daily function. This helps us design an appropriate long-term care plan, whether surgical or non-surgical.

How is Spinal Stenosis treated?

Treatment for spinal stenosis focuses on relieving nerve compression, reducing pain, and restoring mobility. Our priority is to manage your condition using minimally invasive, and evidence-based methods tailored to your lifestyle, and health status. While some patients may respond well to conservative care, others with severe or progressive symptoms may require surgical intervention.

Medications

Minimally Invasive Procedures

Surgical Intervention

Physical and Rehabilitative Therapies

Lifestyle Modifications

Summary

At Apicare Pain Clinic, we understand how spinal stenosis can affect not just your mobility, but your confidence, and quality of life. Whether you are struggling with persistent back pain, leg numbness or difficulty walking, you do not have to face it alone.

We believe in compassionate care using minimally invasive, image-guided techniques designed to relieve pain, and restore movement without surgery whenever possible. From accurate diagnosis to tailored treatment, and rehabilitation, we are here to support you every step of the way.

Let us help you move better, feel stronger, and live life fully again. Book a consultation with us today for a detailed diagnosis and personalised treatment plan.