SPINAL STENOSIS

Spinal stenosis is a narrowing of the spaces within the spine, which can put pressure on the spinal cord and the nerves that travel through the spine. It most commonly occurs in the lumbar spine (lower back) and the cervical spine (neck) and is one of the most frequent causes of spine surgery in adults over 65.

The narrowing is most often caused by age-related degenerative changes — thickened ligaments, enlarged facet joints, bone spurs, and bulging discs gradually encroach on the space available for the nerves. Less commonly, stenosis can result from a congenital narrow spinal canal, spinal injuries, or tumors.

Lumbar stenosis classically causes neurogenic claudication — pain, heaviness, numbness, or tingling in the buttocks and legs that develops with walking or standing and is relieved by sitting down or leaning forward (such as pushing a shopping cart). Cervical stenosis can compress the spinal cord itself, causing difficulty with balance, coordination, fine motor tasks, and in severe cases, weakness in the arms and legs. Spinal stenosis is primarily a condition of aging, with most patients developing symptoms after age 50. It is progressive, though the rate of progression varies. Many patients manage their symptoms effectively for years with conservative treatment.

Treatment begins with non-surgical management for the majority of patients. Dr. Daniel Oh develops individualized conservative treatment plans that may include physical therapy focused on core strengthening, flexibility, and aerobic conditioning. Anti- inflammatory medications help manage pain and inflammation. Epidural steroid injections can provide significant relief by reducing swelling around the compressed nerves, often lasting weeks to months. Activity modification, including using a cane or walker for balance and taking rest breaks during walking, can help patients maintain their independence.

When conservative treatment no longer controls symptoms and stenosis is significantly limiting daily activities, Dr. Chris Howe and Dr. Jason Thompson may recommend surgical decompression. The most common procedure is a laminectomy, in which the bone and thickened ligaments compressing the nerves are removed to create more space. If there is instability or significant deformity, a fusion may be performed at the same time. Decompression surgery has a success rate of approximately 80 to 85%, with most patients experiencing significant improvement in their ability to walk and stand comfortably. Procedures are performed at Proliance Surgery Center at Valley in Renton.

After decompressive laminectomy, most patients are up and walking on the first day. Hospital stays range from same-day discharge to two to three nights depending on the extent of the surgery and whether a fusion was performed. Activity restrictions include avoiding bending, twisting, and heavy lifting for six to twelve weeks. Walking is strongly encouraged and gradually increased. Physical therapy begins within the first few weeks. Most patients notice meaningful improvement in their walking ability within the first month. Full recovery takes two to six months for decompression alone and up to twelve months when fusion is included. Approximately 80% of patients report good to excellent outcomes.