Spinal Stenosis
Spinal stenosis is narrowing of the channels that the spinal cord and nerves travel through. In the low back it classically causes heaviness, aching, or numbness in the legs with walking or standing that eases with sitting or leaning forward. In the neck it can affect the spinal cord itself. Both are common after 60, and both are treatable.
Why stenosis happens
With age, the discs lose height, the facet joints enlarge, and the ligaments inside the canal thicken. Each change takes a little room away from the nerves. When enough room is lost, the nerves are squeezed, particularly when standing upright, which narrows the canal further. Leaning forward opens the canal, which is why people with lumbar stenosis often feel better pushing a shopping cart.
Stenosis in the neck (cervical stenosis) is different in an important way: it can compress the spinal cord rather than individual nerves. That condition, cervical myelopathy, can cause hand clumsiness, imbalance, and changes in walking, and is discussed on its own page.
Recognizing lumbar stenosis
The pattern is the key. Symptoms come on with walking or prolonged standing, involve one or both legs, and are relieved by sitting, bending forward, or lying down. Patients often describe a shrinking walking distance over months to years. Back pain may or may not be part of it. This pattern is called neurogenic claudication and is distinct from leg pain caused by circulation problems, which the examination can usually tell apart.
Nonsurgical care
Stenosis is slowly progressive, but it is not dangerous in most cases, and there is no rush to surgery. Physical therapy focused on flexibility, core strength, and conditioning can meaningfully extend walking tolerance. Anti-inflammatory medication helps some patients. Epidural steroid injections can provide weeks to months of relief and are reasonable to repeat within limits.
A trial of nonsurgical care of at least several weeks is standard before surgery is discussed, unless there is significant weakness or other neurologic change.
Decompression surgery
When symptoms limit life despite good nonsurgical care, surgery to open the canal (decompression) is effective and predictable for leg symptoms. A laminectomy or laminotomy removes the bone and thickened ligament pressing on the nerves. Minimally invasive techniques allow this through small incisions with less muscle disruption and a faster early recovery.
Fusion is added only when the spine is unstable, most often with spondylolisthesis, or when enough bone must be removed that the segment would become unstable. Dr. Michael's preference is the least invasive operation that reliably solves the problem; adding a fusion when it is not needed lengthens recovery without improving results.
Common questions
Does spinal stenosis get worse?
It tends to progress slowly over years, but the pace varies widely and many people plateau. Regular activity and therapy help maintain function. Surgery is elective in most cases and is timed to your symptoms and goals.
Is stenosis surgery a fusion?
Usually not. Most stenosis is treated with a decompression alone. A fusion is added when there is instability, such as a slipped vertebra, or when the decompression would leave the segment unstable.
How long is recovery from a laminectomy?
Many patients walk the same day and go home within a day. Light activity resumes within one to two weeks and most people are back to normal activities within six weeks. Minimally invasive approaches shorten the early recovery.
Can I have stenosis surgery if I am older?
Age alone is not a barrier. The decision depends on overall health, the severity of symptoms, and what you hope to regain. A decompression is a well-tolerated operation in appropriately selected older patients.