Spinal stenosis is a degenerative condition characterized by narrowing of the spinal canal, lateral recesses, or neural foramina, resulting in compression of the spinal cord or nerve roots. It most commonly affects the cervical and lumbar regions and typically develops as a consequence of age-related degenerative changes involving intervertebral discs, facet joints, ligaments, and bony structures. Progressive neural compression can lead to significant pain, neurological dysfunction, and impaired mobility.

Clinical presentation depends on the spinal level involved. Lumbar spinal stenosis commonly manifests as neurogenic claudication, characterized by lower limb pain, numbness, or weakness triggered by walking or standing and relieved by sitting or spinal flexion. Cervical spinal stenosis may cause radiculopathy or myelopathy, with symptoms including neck pain, upper limb weakness, gait instability, hand clumsiness, and upper motor neuron signs. Symptoms typically progress gradually but may acutely worsen following minor trauma.

Neurosurgical evaluation focuses on correlating clinical findings with imaging evidence of neural compression. Magnetic resonance imaging is the diagnostic modality of choice, providing detailed assessment of canal dimensions, neural element compression, and associated degenerative changes. Computed tomography may complement evaluation in cases with complex bony anatomy.

Initial management of spinal stenosis may be conservative in patients with mild symptoms and no neurological deficits. However, surgical intervention becomes indicated when patients develop progressive neurological impairment, disabling claudication, or refractory pain affecting functional capacity. The primary surgical objective is decompression of neural elements while preserving or restoring spinal stability.

Decompressive procedures are tailored to the pattern and extent of stenosis. In selected cases, stabilization may be required to address concomitant instability or prevent postoperative deformity. Surgical planning prioritizes adequate decompression with minimal disruption of normal anatomy to reduce morbidity.

Postoperative outcomes are generally favorable when surgery is performed for appropriate indications. Patients typically experience improvement in pain, walking tolerance, and neurological function. Long-term follow-up focuses on rehabilitation, symptom monitoring, and management of adjacent segment degeneration.

Spinal stenosis represents a common indication for neurosurgical intervention and requires precise diagnosis, careful patient selection, and individualized surgical strategy to achieve optimal neurological and functional outcomes.