The spine is an epic and essential piece of equipment. It not only supports the weight of your upper body and keeps you erect, but it also protects your spinal cord and nerves, which carry the signals that control your body’s movements and convey its sensations.
But by age 50, up to 95 percent of the populace has been affected by degenerative spinal changes, including spinal stenosis, according to Cleveland Clinic.
“Spinal stenosis happens when the space inside the backbone is too small. This can put pressure on the spinal cord and nerves that travel through the spine, most often affecting the lower back and the neck,” according to Mayo Clinic.
That sounds a bit grim, but fortunately there are many new advances and effective treatments available for the condition.
Paul Keller, MD, an orthopedist at Health First’s Medical Group, says, “Spinal stenosis is often helped by non-surgical intervention. Physical therapy and epidural or steroid injections can help the symptoms but don’t cure the disease.
“Surgical treatment, generally decompression or laminectomy, are now minimally invasive procedures, with smaller incisions, shorter hospital stays, and quicker rehab. They are more efficient and treatment is very effective.” adds Dr. Keller.
Mayo Clinic says medical management tools include:
- Watchful waiting – appropriate for individuals with asymptomatic stenosis, with mild or primarily axial symptoms, who prefer to wait before trying interventions.
- Physical therapy – weight loss and physical therapy are common first line treatments. PT uses a mix of exercises and movements that help correct posture, address radicular symptoms, stretch the low back and lower limbs, and strengthen the supporting core and trunk musculature.
- Medications – including topical agents such as lidocaine, menthol, camphor and capsaicin, over-the-counter analgesics and anti-inflammatories, and neuropathic agents such as gabapentin and pregabalin.
- Injections – the effectiveness and longevity of benefit from these injections can vary depending on the cause and severity of the condition.
“Spinal stenosis is a narrowing of the spinal canal that can affect various parts of the spine,” Dr. Keller explains. “Pain is one byproduct of spinal stenosis, but others include numbness or weakness in the legs, as well as radiating pain.
“Generally speaking, stenosis is arthritic in nature. Sometimes it can be caused by a congenital situation.
“Stenosis most frequently causes pain in the lumbar (lower back, vertebrae L1-5) or cervical (neck, vertebrae C1-7) spine. The thoracic spine (middle of the back, vertebrae T1-12) is not as affected because it doesn’t move as much.”
There are many causes of spinal stenosis. “Obesity and smoking are both related to arthritic changes in the spine, or an injury might set you up to develop stenosis in the future,” says Dr. Keller.
Penn Medicine, the health system of University of Pennsylvania, adds the following, which are in addition to the normal effects of aging:
- Some people are born with less space for their spinal cord.
- Spinal disks become drier and start to bulge and can rupture.
- Bones and ligaments of the spine thicken or grow larger. This is caused by arthritis or long-term swelling.
- Arthritis of the spine, usually in middle-aged or older people.
- Bone diseases, such as Paget disease.
- Defect or growth in the spine that was present from birth.
- Herniated or slipped disk, which often may have happened in the past.
- Injury that causes pressure on the nerve roots or the spinal cord.
- Tumors in the spine.
- Fracture or injury of a spinal bone.
When is it the right time to seek treatment for spinal stenosis?
“You should seek professional medical care if you’re dealing with any symptoms of spinal stenosis – pain, tiredness in the legs, tingling and, most importantly, weakness. Weakness is the No. 1 thing that doctors look for. Early intervention is important in the treatment of spinal stenosis,” says Dr. Keller.
New, innovative treatments include ultra-minimally invasive endoscopic spine surgery, which uses a high-definition endoscope to visualize and carefully decompress the affected neural structures with precision, offering a minimally invasive approach that minimizes disruption to surrounding tissues and accelerates recovery.
FIX24is another innovative treatment that focuses on restoring normal biomechanical alignment, based on mechanical engineering principles, to relieve spinal nerve pressure and enhance overall health.
Paul Keller, MD, is an orthopedist specializing in spinal fusion, spinal stenosis and spondylosis, among other conditions. He received his medical degree from University of Chicago Division of the Biological Sciences, the Pritzker School of Medicine. Dr. Keller was recently named to Newsweek magazine’s list of “America’s Leading Doctors” for 2025, his second straight appearance on the list. His office is located at Health First Medical Group Crane Creek, 2222 S Harbor City Blvd., Suite 420, Melbourne. Call 321-768-9914 for an appointment.
