We use the term stenosis in a variety of contexts. If you read your MRI report you may read reference to stenosis of the central canal, or the little holes on the right or left side, or even of the lateral recess which is part of the central canal.
Clinically, i.e. the way we assess patients in the clinic, when we use the term stenosis, it has a different meaning. Clinically, the term stenosis, means a patient presentation where the person is typically bent forward and finds that position more comfortable than standing upright. That happens as a result of degenerative changes of the discs and vertebrae and ligaments which combine to make the canal very narrow. The patient finds relief of their pain by bending forward, which opens up the canal a little bit, and provides some relief. This patient will typically have a bent forward posture whenever they are upright or walking. They may walk by leaning on a shopping cart when they’re in the grocery store. They will, also, typically sit down and find relief by sitting which opens up the canal by bending the low back forward a little bit. They will also typically have limited tolerance for prolonged standing and walking. They will also find it difficult or impossible to bend backwards.
Typically, people with mild to moderate stenosis will find relief from spinal decompression treatment. If, however, the stenosis is very severe, then they may need surgical decompression. In this procedure part of the bones, joints and ligaments are removed to provide more space for the nerves that are getting pinched. This is typically done at one or more levels where the narrowing is most severe. The potential problem with this surgical procedure, however, is that removing some of the bone and joint, which is necessary to relieve the symptoms, may result in subsequent instability of the spine, resulting in slippage of the spine, which may need to be corrected later by fusing the spine at that level. Considerations for surgical treatment of stenosis, is dependent on the specific details of the patient’s problem and their clinical presentation. Like other medical procedures, doing surgery for spinal stenosis is a risk/benefit analysis. Sometimes it’s an ideal surgical procedure for the right patient. I have referred many patients for this surgery, when indicated.
Having spent four years in a neurosurgical practice, part-time, I am well versed in the indications for surgical treatments including that for spinal stenosis. I can provide an alternative to surgical treatment for spinal stenosis when possible, and I can provide referral for surgery when indicated. If you want to try to avoid surgery for spinal stenosis I highly recommend you see me for a second surgical opinion. I want the best solution for your problem, and I’m happy to refer you to surgery when it’s indicated. Oftentimes, however, the only way to know if surgery is indicated is by exhausting your nonsurgical options to see if it will help sufficiently, and I provide the best alternative option to spinal stenosis surgery.