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h2>Lumbar spinal stenosis

A narrowing of the lower spinal canal

About 1 in 5 patients I operate on are suffering from a narrowing of the lower spinal canal, also known as lumbar spinal stenosis.

This condition is less well known than spinal disc herniation, but presents patients with similarly unpleasant symptoms. Patients not only suffer backache and sore legs, but also reduced mobility, which makes walking long distances agony for them. It is fairly easy to explain how these symptoms develop. No doubt you are familiar with the expression, ‘tightening the thumbscrews’. Thumbscrews were horrible torture instruments which were used in the old days to pressure prisoners into making confessions. The process involved placing a prisoner’s thumb in a vice, then tightening a screw. As the thumb got crushed harder, thus compressing the nerves in the thumb, the prisoner would experience more pain. There is little doubt that prisoners who had undergone this form of torture for a considerable period of time would experience pain for quite a while after their thumbs had been released. In much the same way, lumbar spinal stenosis develops from increasing compression of the spinal nerves. These nerves can be released through surgery. Depending on the duration and degree of the compression, patients will make some degree of recovery.

How does such a narrowing of the lower spinal canal develop?

While there are patients who were born with the condition, it is generally a condition that affects ageing persons. Our bodies change as we grow older. Some people grow broader noses in old age, while others grow larger ears. Likewise, there are people whose connective tissue and facet joints in the canal surrounding the sciatic nerves grow in volume. Noses have room to grow. However, the nerves inside our spinal canal have no room to grow, so if they do grow, they will be compressed. Like prisoners having their thumbs crushed harder and harder by torturers, patients will experience more and more pain – generally, at first, when walking.

What kind of symptoms are you experiencing?

Lumbar spinal stenosis differs from a hernia in that hernias typically present with acute backache and sore legs. Lumbar spinal stenosis has a much slower and more gradual onset. You will notice that you will gradually be able to walk less and less far. One or both of your legs will start hurting while you are walking; either your leg muscles will start cramping up or your legs will begin to feel heavy. Alternatively, you may get a burning sensation or pins and needles in your legs, so bad that you will want to stop walking just to wait for the pain to subside. Often, though, your body will prove to be quite clever; you will spontaneously wish to bend over, and you’ll find that this position will relieve your symptoms. In a way, bending forward loosens the thumbscrew. This is why you will generally be able to go on cycling even when you are having a hard time walking. While riding a bike, you will often be a little bent over, thus easing up the compressed spot in your lower spinal canal. By the same token, you will find that your pain will be less severe if you lean on your trolley while out shopping.


If your symptoms are stopping you from going about your daily life, and if all other remedies, such as painkillers and/or physiotherapy, are no longer effective, you may benefit from seeing a neurologist. The thumbscrew described above tends to be easily spotted in an MRI scan. If your symptoms are so severe that they are making you acutely unhappy, you are likely to benefit from decompression surgery (refer to the ‘lumbar spinal stenosis’ section elsewhere on this website), and a neurologist will refer you to a neurosurgeon if you are so inclined. A Dutch pioneer in this field, Professor Verbiest, who lived and worked in Utrecht all his life, was the first to discuss this disorder in great detail, back in 1973. He also came up with a way to treat it. By now the surgical technique he originated is known and performed all over the world. It is called hemilaminectomy, but never mind about the name. Chances are you’ll just want to know whether these techniques actually work. The good news is that 8 in 10 patients are able to walk significantly longer distances after the operation, without sore legs preventing them from moving about. However, the remaining two patients will unfortunately have to accept that that the nerve has been damaged to the point where it will never make a complete recovery. In the event that this should be the case for you, rest assured that I will not leave you in the lurch. In such an event I will arrange for you to see our excellent anaesthetist Dr Poell, who specialises in pain management and has many means at his disposal to make what pain you still have bearable for you. All things considered, there is a significant chance that your symptoms will be reduced, and you’ll feel intensely relieved once you’re able to walk your dog again, or buy some groceries on foot. The thumbscrews will have been released, and you will no longer feel like a prisoner of your own body.

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Surgery manual

Dr. Schröder is happy to inform you about the surgical treatment of your neck or back condition. He also discusses the possible complications of the procedure with you.

After you've carefully weighed up the pros and cons of the surgery, you can decide for yourself whether you consider your condition serious enough to operate.

View the surgery manual

  • Instructions for after you have left the clinic

    Once you leave the clinic:

    • Make sure that someone comes and picks you up in a car, and refrain from driving yourself
    • Make sure that you recline your car seat
    • Make sure that you are not home alone for the first few days following the operation
    • Allow the wound to heal for the first 2 to 3 weeks
    • You are allowed to shower, as the nurses will give you a waterproof plaster to cover your wound before you leave the clinic
    • You must not drive for 3 weeks, but you will be allowed to sit in the passenger seat while someone else drives you around
    • You are allowed to do whatever you feel up to, as long as you keep listening to your body and stop doing whatever it is you are doing whenever your body tells you to stop

    Your doctor, nurse and/or physiotherapist will provide you with more information on how to look after yourself following the operation.

  • How long will I have to stay at the clinic?

    Depends on the nature of the operation

    The duration of your stay with us will depend on your situation and on the type of surgery you are undergoing. If everything goes according to plan, and if you are undergoing a minor back or neck operation, you will only have to stay with us for one night. If you are undergoing major surgery, such as a spinal instability operation, you will generally have to spend a few nights at our clinics.

  • Swelling after surgery

    Swelling reduced after 2 to 3 months

    After the operation, your wound will swell, which may be painless but may also be a little uncomfortable due to your skin being pulled so taut. Generally speaking, the swelling will subside of its own accord within 2 to 3 months of the operation, and the skin will grow less thick.

  • Medication after surgery

    Following the operation, you will be given painkillers for as long as you need them. You will receive these painkillers in accordance with a set schedule. It is vital that you take your medication at the scheduled times, even when you are not experiencing any pain. In this way, your body will build up a steady level of analgesia.

    Most people will be able to stop taking painkillers a few days after undergoing back or neck surgery. If your painkillers somehow fail to provide you with a sufficient level of relief, we recommend that you notify a nurse as soon as possible. If you were on morphine-like medication prior to your operation, we advise that you gradually cut down on your medication after the operation, if your level of pain allows you to do so, in consultation with your GP. Acute withdrawal may result in adverse events.

  • Post-operative pain

    If you are experiencing an excessive amount of pain, you will receive additional painkillers

    The level of post-operative pain differs from person to person, and from operation to operation. Generally speaking, major lengthy operations will prove more painful than brief minor operations. At our clinics, all patients receive proper painkillers following surgery, as a result of which very few of our patients ever experience a great deal of pain. In consultation with yourself, we will determine your pain score, both at the ward and once you are home (we will call you to discuss this with you). If your pain score is too high, you will be given additional painkillers.

100% insurance covery

Nearly all treatments performed by Dr Schröder are covered by health insurance. This is true for the following conditions: neck hernia, spinal hernia, lumbar spinal stenosis and cervical spinal stenosis.

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Dr Schröder's blog

Dr Schröder regularly publishes new articles on his blog. Read all about spinal hernia, neck hernia, spinal stenosis, neurosurgery and other related subjects.

View all blog posts

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