Spinal Stenosis Treatment Bangkok | Dr. Chaidej Sasomboon

What is Spinal Stenosis?

Spinal stenosis is a narrowing of the spinal canal or nerve root tunnels (foramina) that compresses the spinal cord or nerve roots. It is among the most common reasons adults over 50 seek spine surgery. Unlike acute disc herniation, stenosis develops gradually over years as disc height loss, facet joint hypertrophy, ligamentum flavum thickening, and osteophyte formation progressively narrow the canal.

Types of Spinal Stenosis

• Lumbar central canal stenosis (most common): Compression of the cauda equina nerve roots causing neurogenic claudication — bilateral leg pain and heaviness with walking, relieved by sitting or forward bending.
• Cervical stenosis: Spinal cord compression (myelopathy) causing hand clumsiness, gait disturbance, and balance problems. Can progress to paralysis if untreated.
• Foraminal stenosis: Narrowing of the lateral nerve root tunnel causing one-sided radiculopathy — similar presentation to disc herniation.
• Lateral recess stenosis: Narrowing of the subarticular space before the nerve exits the foramen — causes positional leg pain.

Neurogenic vs Vascular Claudication

Neurogenic claudication (spinal stenosis): Bilateral leg pain with walking relieved by sitting or forward bending. Patients can typically cycle without symptoms. Pedal pulses present. MRI shows canal narrowing.

Vascular claudication (arterial disease): Leg pain with walking relieved by standing still — NOT by flexion. Cannot cycle without pain. Reduced pedal pulses. Requires vascular workup, not spine surgery.

Symptoms of Lumbar Spinal Stenosis

• Neurogenic claudication: Bilateral leg heaviness, pain, and numbness that builds with walking and resolves when sitting. Walking distance progressively shortens over months.
• Radiculopathy: Shooting pain down one or both legs from compressed nerve roots.
• Back pain: Aching pain worsened by standing and spinal extension, improved by sitting and flexion.
• Myelopathy (cervical stenosis): Hand clumsiness, wide-based gait, hyperreflexia, bladder urgency — indicates spinal cord compression requiring urgent surgical evaluation.

Diagnosis

• MRI (gold standard): Shows disc bulges, ligamentum flavum thickening, facet hypertrophy, and degree of canal narrowing. Dynamic MRI reveals positional changes.
• CT scan / CT myelogram: Better bony anatomy detail. CT myelogram provides excellent canal definition when MRI is contraindicated.
• Standing flexion-extension X-rays: Assess instability — dynamic spondylolisthesis worsening with movement indicates need for fusion rather than decompression alone.

Conservative Treatment

• Physiotherapy: Flexion-based exercises, cycling, and aquatic therapy open the spinal canal. Core strengthening reduces mechanical load on stenotic segments.
• Epidural steroid injections: Reduce nerve root inflammation — provide weeks to months of relief and help select surgical candidates.
• Medications: NSAIDs, gabapentin, and pregabalin manage neuropathic pain but do not address structural stenosis.
• Walking aids: A shopping trolley, walker, or forward-leaning posture opens the canal and extends walking tolerance.

Surgery is indicated for disabling neurogenic claudication, progressive neurological deficits, myelopathy, or failure of 3-6 months of conservative therapy.

Surgical Treatment at Bangkok International Hospital

Unilateral Biportal Endoscopy (UBE) Decompression

Dr. Chaidej’s preferred technique for lumbar stenosis. Two 8-10 mm portals allow independent endoscope and instrument manipulation. Bilateral decompression is achieved through a unilateral approach using the over-the-top technique — removing hypertrophied ligamentum flavum and bone spurs from both sides without disrupting the posterior midline. Hospital stay 1-2 nights. Walking same day. Office work in 2-3 weeks.

Uniportal Full-Endoscopic Decompression

Full-endoscopic decompression uses a single 8-10 mm working channel endoscope — combining the visualisation and irrigation system into one portal. A high-definition camera, light source, and surgical instruments all pass through the same endoscope sheath, making this the most minimally invasive option for lumbar spinal stenosis.

The endoscope is advanced to the stenotic segment via a transforaminal or interlaminar approach under continuous saline irrigation, which maintains a clear operative field and reduces thermal injury risk. Hypertrophied ligamentum flavum, medial facet bone, and any compressing disc material are removed under direct endoscopic vision with specialised punch forceps and a high-speed drill.

• Single 8-10 mm incision — no retraction, minimal soft tissue disruption
• Bilateral decompression via unilateral approach — over-the-top technique decompresses both sides through one portal
• Day surgery or 1 night admission — walk same day, discharge next morning
• Return to desk work: 1-2 weeks
• Full activity: 4-6 weeks

Compared to UBE (two portals), uniportal full-endoscopy uses only one incision and is performed entirely within the fluid-filled endoscopic environment — offering faster setup, reduced muscle trauma, and excellent results for single-level central and foraminal stenosis.

Microscopic Laminectomy or Laminotomy

Traditional decompression through a 3-4 cm incision with microscopic magnification. Highly effective for multi-level or complex stenosis. Hospital stay 2-3 nights. Office work in 3-4 weeks.

Dr. Chaidej Sasomboon — Spinal Stenosis Specialist, Bangkok

• Fellowship: Minimally Invasive Spine Surgery, UCSF Medical Center (2019)
• Fellowship: Complex Spine Surgery, Columbia University Medical Center (2020)
• Residency: Ramathibodi Hospital, Mahidol University
• Member: NASS, RCST, Thai Medical Council

Recovery After Stenosis Surgery

• UBE endoscopic decompression: Walk same day — 1-2 nights — office work 2-3 weeks — full activity 6-8 weeks
• Microscopic laminectomy: Walk next day — 2-3 nights — office work 3-4 weeks — full activity 8-12 weeks