Spinal Stenosis

Spinal stenosis is a condition where the spaces within the spine gradually narrow, reducing the room available for the spinal cord or exiting nerve roots. It most commonly affects the cervical spine (neck) and lumbar spine (lower back). When treatment is delayed, progressive narrowing may lead to increasing nerve irritation and reduced mobility.

Gradually, individuals may experience worsening walking tolerance, persistent limb weakness, balance difficulties or reduced coordination. In more severe cases, prolonged nerve compression can result in permanent nerve damage or loss of bladder or bowel control, which requires urgent medical attention.

What causes spinal stenosis?

The condition develops through structural changes that reduce space within the spine, rather than a single injury event. This includes:

Degenerative changes

• Disc degeneration — loss of disc height reduces the spacing between vertebrae, allowing surrounding structures to encroach into nerve pathways.
• Facet joint enlargement — arthritic changes in spinal joints cause thickening and enlargement, which can narrow the spinal canal or nerve exit openings.
• Ligament thickening (ligamentum flavum hypertrophy) — age-related thickening of spinal ligaments reduces canal space and contributes to nerve compression.

Alignment and structural contributors

• Spondylolisthesis — vertebral slippage alters spinal alignment, reducing the space available for nerves.
• Scoliosis or spinal curvature — abnormal curvature creates uneven pressure and focal narrowing within the spinal canal.

Space-occupying conditions

• Herniated discs — bulging or displaced disc material can further narrow an already tight spinal canal.
• Bone spurs (osteophytes) — bony overgrowth from degenerative arthritis can directly compress nerve structures.

What are the symptoms of spinal stenosis?

Symptoms vary depending on the location and severity of narrowing, but may include:

Cervical spinal stenosis (neck)

• Neck pain or stiffness
• Radiating pain into the shoulders, arms or hands
• Numbness or tingling in the arms or fingers
• Weakness affecting grip or arm function
• Balance or coordination difficulties, particularly in more advanced cases

Lumbar spinal stenosis (lower back)

• Lower back pain that worsens with standing or walking
• Radiating pain into the buttocks, thighs or legs
• Numbness or tingling in the legs or feet
• Heaviness, cramping or fatigue in the legs during walking, which improves with sitting or bending forward (neurogenic claudication)
• Weakness or reduced endurance in the lower limbs

Who is at risk of spinal stenosis?

Some people are more likely to develop spinal stenosis because their spine has less capacity to accommodate normal age-related changes or because it is exposed to higher mechanical stress over time. These include:

• Older adults — with ageing, discs lose height, joints enlarge and spinal ligaments thicken, all of which gradually reduce the space available for the spinal cord and nerve roots.
• People born with a narrow spinal canal — when baseline space is limited, even mild degenerative changes can result in earlier or more pronounced nerve compression.
• Individuals with previous spinal injuries — previous trauma can alter spinal alignment or accelerate wear in the affected segments, increasing the likelihood of narrowing later on.
• People with physically demanding occupations — repeated lifting, bending or prolonged physical strain places ongoing stress on spinal joints and supporting structures, encouraging thickening and stiffness that reduce spinal space.
• Poor posture or prolonged sedentary habits — sustained positions, particularly prolonged sitting or slouched postures, increase uneven loading on the spine, contributing to gradual structural narrowing.
• Obesity — additional body weight increases axial load through the spine, accelerating degenerative changes that can narrow spinal canals and nerve exit pathways.

How is spinal stenosis diagnosed in Singapore?

Accurate diagnosis is important to confirm spinal stenosis, assess its severity and distinguish it from other causes of neck or lower back symptoms. Dr James Tan carries out a structured evaluation to understand how spinal narrowing is affecting nerve function and daily activities.

• Clinical history — this focuses on how symptoms relate to posture and activity, such as walking tolerance, relief with sitting or forward bending and gradual progression over time. Previous spine conditions or injuries are also reviewed.
• Symptom review — this helps clarify the extent of nerve involvement by assessing:
  • Distribution of pain into the arms or legs
  • Presence of numbness, tingling or limb weakness
  • Functional limitations, including difficulty standing, walking distances or maintaining balance
• Physical examination — Dr James will evaluate neurological and functional impact through:
  • Assessment of spinal movement and posture
  • Muscle strength, reflexes and sensory testing
  • Gait and coordination assessment to detect subtle balance or walking changes
• Imaging examination — when needed, imaging helps to determine structural-related causes:
  • X-ray — to evaluate spinal alignment, joint changes or vertebral slippage
  • Magnetic Resonance Imaging (MRI) — to visualise canal narrowing, nerve root compression and soft tissue involvement
  • Computed Tomography (CT) scan — used selectively for detailed assessment of bony structures or complex anatomy
  • Myelogram — a specialised contrast-based imaging study that outlines the spinal cord and nerve roots

How is spinal stenosis treated in Singapore?

Treatment is tailored based on symptom severity, functional impact and imaging findings.

Conservative management

• Activity modification — avoiding positions or activities that aggravate symptoms
• Pain management — medications to control inflammation and discomfort
• Education — guidance on posture and daily movement strategies

Non-surgical interventions

• Oral medication — nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain and nerve-related symptoms during flare-ups
• Physiotherapy programmes — flexion-based exercises, strengthening and walking tolerance training
• Platelet-rich Plasma (PRP) injections — may be considered in selected cases to help modulate inflammation and support surrounding tissues, particularly in mild to moderate symptoms
• Epidural steroid injections — targeted anti-inflammatory medication to reduce nerve irritation and improve mobility
• Supportive bracing — short-term symptom relief in selected cases
• Nucleoplasty / annuloplasty — aimed at reducing internal disc pressure or addressing contained disc disruption
• Nerve root injection — an image-guided injection to pinpoint and reduce inflammation at the symptomatic nerve level
• Radiofrequency ablation — controlled thermal therapy used to interrupt pain signalling in carefully selected cases

Surgical management (selected cases)

• Decompression surgery — removal of structures compressing the spinal cord or nerves
• Minimally invasive spine surgery — used where appropriate to reduce tissue disruption and recovery time

Rehabilitation and recovery

• Physiotherapy programmes — flexion-based exercises, strengthening and walking tolerance training
• Walking tolerance programmes — help increase distance and stamina, allowing patients to return to daily activities
• Postural retraining — encourages safe movement patterns and prevents further narrowing or nerve irritation
• Long-term symptom control — help maintain spinal health, minimise flare-ups and support lasting quality of life

Book an Appointment

If walking tolerance is decreasing, pain is limiting daily activities or symptoms are gradually worsening, an early assessment can help clarify what is happening in your spine.
Speaking with Dr James Tan helps clarify what is causing your symptoms and what options are available to keep you moving comfortably. Calling to book an appointment is the first step toward a clear plan that supports mobility, confidence and long-term spine health.