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Lumbar Radiculopathy

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Overview

Lumbar spinal stenosis is a narrowing of the spinal canal in the lower back, which can compress the spinal nerves and cause pain, numbness or weakness in the legs. It typically develops due to age-related wear and tear, bone spurs or disc changes. Many people manage symptoms effectively with conservative care, though surgery may be needed if pain persists or neurological function declines.

Symptoms

  • Leg pain, heaviness or cramping, especially when walking or standing for prolonged periods.
  • Pain often eases with rest, sitting or leaning forward.
  • Numbness or tingling in the legs, buttocks or feet.
  • Weakness in the legs or difficulty with balance.
  • In severe cases, loss of bladder or bowel control (seek urgent assessment).

Causes

  • Age-related degeneration: disc bulging, facet joint enlargement and ligament thickening as the spine ages.
  • Bone spurs (osteophytes): extra bone growth narrowing the nerve space.
  • Disc herniation or bulging: material pressing into the spinal canal.
  • Thickened ligaments: the ligamentum flavum can narrow the canal with age.
  • Less commonly, scoliosis, previous spine surgery or spinal tumours.

Diagnosis

Diagnosis typically combines clinical assessment and imaging.

  • Clinical examination: testing strength, reflexes, sensation and ability to walk to assess nerve function.
  • MRI: the main scan to show the degree and location of canal narrowing and nerve compression.
  • X-rays or CT: may be used to evaluate bone structure or in cases where MRI is not suitable.
  • Imaging may show: reduced canal space, disc bulging, facet joint enlargement or ligament thickening.
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Non‑surgical treatment

Most people start with conservative care, especially if symptoms are mild to moderate and stable.

  • Activity modification: staying active while avoiding prolonged walking or standing; using a shopping trolley or walking frame can help.
  • Medications: pain relief, anti-inflammatories (NSAIDs) or neuropathic pain medicines, tailored to your needs.
  • Physiotherapy: stretching, core strengthening and exercises that improve flexibility; bending forward often eases symptoms.
  • Epidural steroid injections: image-guided injections around the affected nerves to reduce inflammation and pain.
  • Postural support: back supports may provide temporary relief during activities.

Conservative treatment often provides sustained relief over months to years with consistent activity and exercise.

Surgical treatment

Surgery is usually considered when pain remains severe despite adequate conservative care, when there is significant functional decline or progressive neurological loss.

  • Laminotomy or laminectomy: removal of part or all of the lamina (bone at the back of the vertebra) to widen the spinal canal.
  • Foraminotomy: enlargement of the nerve exit holes to decompress nerve roots.
  • In selected cases, stabilisation or fusion may be recommended if there is significant instability or deformity as well as nerve compression.

Evidence suggests surgery can provide faster pain relief for carefully selected patients, though long-term outcomes may be comparable to well-managed conservative care.