Spinal stenosis treatment at the Spine and Performance Institute in Edison, NJ starts with a conservative-first approach. Spinal stenosis is one of the most common reasons adults over 50 develop back pain and leg pain when walking. When surgery is needed, Dr. Alok Sharan, MD, MHCDS performs minimally invasive decompression that can be done awake under regional anesthesia.
Medically reviewed by Dr. Alok Sharan, MD, MHCDS, board-certified orthopedic spine surgeon, Deputy Editor of Clinical Spine Surgery, co-editor of the textbook Awake Spine Surgery, and author of more than 100 peer-reviewed publications.
What Is Spinal Stenosis?
Spinal stenosis is a narrowing of the spaces inside the spine. As the space shrinks, it can squeeze the spinal nerves or the spinal cord. It develops gradually, most often from age-related changes: thickened ligaments, arthritic facet joints, bone spurs, and bulging discs all take up room in the spinal canal. The American Academy of Orthopaedic Surgeons offers a helpful patient overview of lumbar spinal stenosis.
Stenosis is most common in two areas of the spine:
- Lumbar stenosis (lower back): The most common form, usually at the L4–L5 and L5–S1 levels. It compresses the nerves that travel to the legs.
- Cervical stenosis (neck): Less common but potentially more serious, because it can compress the spinal cord itself.
Symptoms of Spinal Stenosis
Lumbar Spinal Stenosis
- Pain, heaviness, cramping, or fatigue in the buttocks and legs when standing or walking (neurogenic claudication)
- Relief when sitting or bending forward, such as leaning on a shopping cart
- Numbness or tingling in the legs or feet
- Lower back pain
- Gradually shrinking walking distance
Cervical Spinal Stenosis
- Neck pain and stiffness
- Pain, numbness, or tingling in the arms or hands
- Clumsy hands: trouble buttoning shirts, writing, or holding objects
- Balance problems or an unsteady walk
The cervical symptoms in the last two bullets can signal cervical myelopathy, or compression of the spinal cord. Myelopathy tends to progress and should be evaluated by a spine surgeon promptly.
When to Seek Immediate Medical Attention
Go to the emergency room if you develop loss of bladder or bowel control, numbness in the groin or inner thighs, or rapidly worsening weakness in the legs. These can be signs of cauda equina syndrome or severe spinal cord compression.
How Is Spinal Stenosis Diagnosed?
- History and physical exam: When symptoms occur, what relieves them, and testing of strength, reflexes, sensation, and balance
- X-rays: Show arthritis, alignment, and instability such as spondylolisthesis. Stenosis itself does not show on x-rays.
- MRI: The best test for seeing narrowing and compression of the nerves and spinal cord
- CT scan or CT myelogram: For patients who cannot have an MRI
You can upload your MRI images for Dr. Sharan to review before your appointment.
Non-Surgical Spinal Stenosis Treatment
Many patients with mild to moderate stenosis manage well without surgery. Dr. Sharan always starts with the least invasive approach:
- Physical therapy: Core strengthening, flexibility, and flexion-based exercises that open the spinal canal
- Medications: Anti-inflammatory and nerve pain medications
- Epidural steroid injections: Reduce nerve inflammation and can provide relief for weeks to months
- Activity modification: Walking aids, stationary cycling, and pacing activities
When Is Surgery Needed?
Surgical spinal stenosis treatment may be recommended if:
- Pain and walking limits persist despite several months of conservative care
- Weakness or numbness is getting worse
- There are signs of cervical myelopathy
- Symptoms significantly limit your daily life and independence
Surgical Spinal Stenosis Treatment
Laminectomy and Decompression
The main surgery for lumbar stenosis. Dr. Sharan removes the bone and thickened ligament that are pressing on the nerves, creating more room in the spinal canal. Using minimally invasive techniques, decompression can be performed awake under regional anesthesia, and many patients go home the same day.
Decompression with Fusion
When stenosis occurs together with spinal instability, such as degenerative spondylolisthesis, decompression alone may not be enough. In these cases Dr. Sharan adds a fusion to stabilize the spine. He is a pioneer of awake spinal fusion, performed under regional anesthesia instead of general anesthesia.
Cervical Stenosis Surgery
For cervical stenosis, the goal is to take pressure off the spinal cord and nerve roots. Depending on the number of levels involved and the alignment of the neck, this may be done from the front with ACDF or from the back with a decompression procedure.
Why Awake Spine Surgery?
- No general anesthesia — often a better fit for older patients and those with heart, lung, or other health conditions, a group that commonly develops stenosis
- Faster recovery — many patients walk the same day
- Research-backed — Dr. Sharan has published research comparing spinal and general anesthesia for lumbar spine surgery, including outcome and cost-effectiveness studies. See his awake spine publications.
Why Choose Dr. Sharan for Spinal Stenosis Treatment?
- Board-certified orthopedic spine surgeon with extensive experience in minimally invasive surgery
- Pioneer in awake spine surgery who has trained surgeons internationally in the technique
- Conservative-first approach — surgery only when it is truly needed
- Convenient Edison, NJ location serving Middlesex, Monmouth, Somerset, and Union counties
Frequently Asked Questions
Does spinal stenosis always require surgery?
No. Many people with mild to moderate stenosis manage their symptoms with physical therapy, medications, and epidural injections. Surgery is considered when symptoms persist despite conservative care, when weakness or numbness worsens, or when there are signs of spinal cord compression.
Why does leaning forward relieve my leg pain?
Bending forward opens up the spinal canal slightly, which takes pressure off the compressed nerves. That is why many people with lumbar stenosis feel better sitting or leaning on a shopping cart and worse when standing upright or walking.
What surgery is done for spinal stenosis?
The most common surgery is a decompression, usually a laminectomy, which removes the bone and ligament pressing on the nerves. If the spine is also unstable, a fusion may be added. For cervical stenosis, ACDF or a posterior decompression may be used.
Can spinal stenosis surgery be done awake?
Yes. Dr. Sharan performs lumbar decompression and fusion under regional anesthesia, so patients avoid general anesthesia. Many go home the same day.
Is spinal stenosis the same as a herniated disc?
No, although they can overlap. Stenosis is a gradual narrowing of the spinal canal, usually from arthritis and thickened ligaments. A herniated disc is a tear in a disc that lets its inner material press on a nerve, and it often comes on more suddenly.
Will spinal stenosis get worse over time?
Stenosis usually progresses slowly, and many patients stay stable for years. Cervical stenosis with myelopathy is the exception: it tends to progress and is usually treated surgically.
Get Relief from Spinal Stenosis
If leg or arm pain is limiting how far you can walk or what you can do, Dr. Sharan and the Spine and Performance Institute team can help you find the right spinal stenosis treatment plan.
Schedule a Consultation or call (732) 898-3950.
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