What Is Spinal Stenosis?
Spinal stenosis is a narrowing of the spinal canal or neural foramina (the openings through which nerve roots exit) that compresses the spinal cord or nerve roots. The most common cause is degenerative changes associated with ageing: bone spurs (osteophytes), hypertrophy of the ligamentum flavum, facet joint arthrosis, and disc collapse. Lumbar stenosis (lower back) is far more common than cervical stenosis (neck).
Symptoms by Type
| Type | Symptoms | Diagnosis |
|---|---|---|
| Lumbar central canal stenosis | Neurogenic claudication: bilateral leg pain/heaviness after walking; better with sitting/bending forward | Walking test, MRI, CT myelogram |
| Lumbar foraminal stenosis | Unilateral leg pain mimicking disc herniation but in older patients with degenerative changes | MRI, electrodiagnostics |
| Cervical spinal stenosis (myelopathy) | Hand clumsiness, balance difficulty, gait instability, weakness; bowel/bladder symptoms in severe cases | MRI cervical spine; urgent assessment |
| Cervical foraminal stenosis | Neck + arm pain/numbness/weakness; similar to herniated disc symptoms | MRI + clinical examination |
Conservative Treatment
- Physiotherapy: Flexion-based exercises (reduce canal narrowing); core strengthening; aquatic therapy
- Pain Management: NSAIDs, gabapentin/pregabalin for neuropathic leg pain
- Epidural Steroid Injections (ESI): Fluoroscopy-guided; provides 3–6 months of significant pain relief in 50–70% of patients; can be repeated 2–3 times per year
- Walking aids: Walking with a slight forward lean (trolley, walking pole) reduces symptoms
- Activity modification: Cycling is well-tolerated (flexed position); swimming excellent
Surgical Options
| Surgery | Description | Private Cost (SGD) |
|---|---|---|
| Decompressive Laminectomy | Removes lamina and ligament to widen the spinal canal; relieves nerve compression | $15,000–$30,000 |
| ULBD (Unilateral Laminotomy for Bilateral Decompression) | Less invasive bilateral decompression through one-sided approach; less destabilising | $15,000–$28,000 |
| Laminectomy + Fusion (TLIF/PLIF) | Required when instability or spondylolisthesis is present alongside stenosis | $25,000–$50,000+ |
| Cervical Laminoplasty | Opens cervical canal while preserving motion; for multi-level cervical stenosis | $20,000–$38,000 |
| Interspinous Process Device (X-STOP, Coflex) | Spacer inserted between spinous processes to maintain canal patency; limited indications | $12,000–$22,000 |
See our researched shortlist: subspecialty focus, credentials and clinic websites, checked against public records.
View the shortlist →A herniated disc involves the inner disc material pushing out and pressing on a nerve — typically affects younger patients (30–50). Spinal stenosis is a narrowing of the spinal canal or foramina (nerve exit holes), usually from degenerative changes — bone spurs, thickened ligaments, and disc collapse — and is more common in patients over 60. Both can cause leg pain (sciatica/neurogenic claudication), but the pattern differs. Stenosis typically causes bilateral leg pain and weakness that improves with sitting or leaning forward.
Neurogenic claudication is the hallmark symptom of lumbar spinal stenosis — leg pain, heaviness, numbness, or weakness that develops after walking a certain distance and is relieved by sitting or leaning forward (like pushing a shopping trolley). It is caused by narrowing of the spinal canal compressing the cauda equina nerve roots. It is distinct from vascular claudication (arterial narrowing), which is not relieved by stooping forward.
Mild to moderate stenosis is often managed conservatively: physiotherapy to strengthen core and hip muscles, NSAIDs, epidural steroid injections (provide 3–6 months of relief in 50–70% of patients), and activity modification. Surgery (decompressive laminectomy, with or without fusion) is indicated when conservative measures fail after 3–6 months, or when neurological deficits (weakness, bowel/bladder dysfunction) are present.
Decompressive laminectomy (removing bone/ligament to widen the canal) at a private hospital: $15,000–$30,000. Laminectomy + spinal fusion (for patients with instability/spondylolisthesis): $25,000–$50,000+. Minimally invasive options (ULBD — unilateral laminotomy for bilateral decompression) have similar costs. All procedures are Medisave and MediShield Life claimable.
Degenerative lumbar spinal stenosis is most common in patients over 60, reflecting the cumulative effects of spinal degeneration over decades. However, congenital stenosis (a narrower-than-normal canal from birth) can cause symptoms earlier, even in the 30s–40s. Cervical stenosis causing myelopathy can affect adults from age 40 onwards.