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When is Time to Have Surgery for Stenosis?

Spinal stenosis is a condition I encounter frequently in my practice as a spine surgeon. I sometimes see patients who have recently developed symptoms, such as leg pain while walking, and are coming to me for a diagnosis. I also have patients who have had spinal stenosis for some time and are noticing a progression of the disease, so they schedule an appointment to discuss new treatment options. But whether they are a new or an established patient, most people who come into my office want to know if surgery is needed to relieve their symptoms of spinal stenosis.

Managing Spinal Stenosis Without Surgery

Spinal stenosis occurs as the result of narrowed spaces within your spine, placing pressure on the nerves traveling through it. This may be caused by conditions such as osteoarthritis, bone spurs, thickened ligaments, or bulging discs. Pinched spinal nerves may cause pain, tingling, numbness, or weakness in the back and extremities.

Though nonsurgical treatments won’t change the structural component of spinal stenosis or remove the “pinch” on your nerves, they may help improve your symptoms. In the majority of cases, we will always try these treatments first.

Most patients will begin with physical therapy and home exercises. Improving muscular strength, endurance, and flexibility can help alleviate pain and make it easier to carry out your normal daily activities.

Pain relievers are commonly used as well. Ibuprofen, naproxen, and acetaminophen may be used to relieve discomfort.

If pain medication isn’t enough, we may also try epidural injections. Injecting a steroid medication around the irritated spinal nerve reduces inflammation and decreases pain, often for an extended period of time.

My patients sometimes ask me about alternative treatments such as massage and acupuncture to relieve their spinal stenosis symptoms. I always tell them, “If it makes you feel better, it makes you feel better.” Once again, these treatments aren’t going to widen the spaces within your spine, but if it eases your pain, then go for it.

Recognizing the Need for Spinal Stenosis Surgery

Though we utilize nonsurgical treatments for spinal stenosis when appropriate, there are times when surgery should be considered:

  • Conservative treatments aren’t providing adequate relief. If you are still in considerable pain and suffering in terms of your quality of life, surgery may provide you a better result.
  • You are experiencing increasing numbness or weakness in your extremities or problems with walking or balance. This often worsens slowly over time, but it may be an indication that it’s time to discuss surgery.
  • You have a rapid or profound weakness or loss of bowel or bladder control. This is a more urgent situation that would warrant a trip to the ER and may require surgery to decompress the nerves.

Fortunately, minimally invasive surgical procedures have been developed to treat cases of spinal stenosis. For example, a laminectomy can be performed to remove part of the bone from the affected area of the spine to create more space and relieve pressure. When this is done using minimally invasive techniques, it causes less trauma to the surrounding tissue, resulting in a shorter recovery time.

I always reassure my patients that spinal stenosis is very common. Nearly everyone will have some element of spinal stenosis as they get older. Although I understand that most people want to avoid surgery (and I will do everything I can to make that happen), sometimes surgery is the best option. We have great success rates for spinal stenosis surgery, and patients report big improvements in their pain and ability to function.   

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Rojeh Melikian, M.D.

About the author

Rojeh Melikian, M.D. Dr. Rojeh Melikian is a Harvard and Emory University-trained orthopaedic spine surgeon. He was subsequently accepted into the prestigious Harvard Combined Orthopaedic Surgery Residency Program, where he excelled and was appointed as Chief Resident at the Massachusetts General Hospital. He received extensive training in complex spinal surgery, scoliosis, as well as primary and metastatic spine tumors. Upon graduation, Dr. Melikian was awarded the prestigious Harvard Orthopaedic Surgery Thesis Day Award for best clinical presentation for his work on spinal infections. Dr. Melikian has authored numerous presentations, posters and journal articles on spine surgery. Read more articles by Rojeh Melikian, M.D..

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