Spinal stenosis and ageing
Most of us expect a stiffer back and a slower start to the morning as the years go on. However, there’s a difference between the general wear that comes with age and spinal stenosis, a specific narrowing of the spinal canal that can press on nerves and cause real, ongoing symptoms.
Telling the two apart matters, because treating one like the other means either overreacting to a normal ageing spine or ignoring a problem that actually needs attention.
Here we’ll explore what spinal stenosis is and how to tell whether what you’re experiencing is natural or not.
Not every ache is spinal stenosis
A systematic review of spinal imaging in people with no back pain at all found that degenerative changes show up constantly, in pain-free people and people with back pain alike. Over 90% of asymptomatic adults aged 60 or older had degenerative findings on their CT or MRI scans. The review’s conclusion was that when these changes turn up as an incidental finding, they should be treated as normal age-related change, not as a disease process.
That’s a useful thing to know if you’ve ever had a scan for one issue and been told, almost in passing, that you have ‘some narrowing’ or ‘degenerative changes’ elsewhere in your spine. On their own, those words on a report don’t mean you have stenosis, and they don’t necessarily explain any pain you’re feeling.
Most ageing spines look a bit worn on a scan. Very few of those spines are actually causing the kind of nerve compression that needs treatment.
The symptoms of stenosis
The distinction between aging and stenosis comes down to symptoms, not scan results. General stiffness, a dull ache after a long day, or reduced flexibility compared to twenty years ago, are all common and, for the most part, unremarkable.
Stenosis tends to present differently like pain, numbness or heaviness in the legs that gets worse with walking or standing and eases when you sit or lean forward is a classic pattern. Weakness, tingling, or a sense that your legs won’t quite cooperate over longer distances is another.
This is why imaging is only ever one part of a proper assessment. A scan showing degenerative changes needs to be matched against what a patient is actually experiencing, as well as against a physical and neurological examination.
When conservative management isn’t helping
Where stenosis is confirmed and genuinely symptomatic, most people start with physiotherapy, activity adjustments and pain management, and a good proportion improve without ever needing surgery.
A systematic review and meta-analysis published in August 2025, covering 14 studies and 1,795 patients, compared minimally invasive endoscopic discectomy against conventional open surgery for lumbar disc herniation. It found comparable, and in several measures superior, outcomes for the minimally invasive approach, alongside lower complication rates. It’s a trend running through spinal surgery more broadly…Smaller access, less disruption to surrounding tissue, and outcomes that hold up just as well, if not better.
That same thinking sits behind the spinal decompression technique Dr Hussien El-Maghraby offers, using AI-analysed imaging and 3D-printed models to map the exact area of narrowing before surgery even begins. It allows a more precise, minimally invasive route to the problem, with less tissue damage and a faster return to normal activity than conventional surgery.
If you’ve been told you have degenerative changes on a scan and aren’t sure whether they explain your symptoms, or if leg pain and walking distance have been getting worse rather than better, it’s worth having it properly assessed. Book a consultation with Dr El-Maghraby today.
