Symptoms
- Sharp, shooting pain down arms or legs
- Numbness or tingling in extremities
- Weakness in affected limb
- Back or neck pain that worsens with movement
- Pain relief when leaning forward or sitting (stenosis)
- Difficulty walking or standing for extended periods
Common Causes
Disc Herniation develops when:
- Disc material ruptures through outer wall, pressing on nerves
- Can happen suddenly (lifting, injury) or from gradual degeneration
- More common ages 30-50
Spinal Stenosis develops from:
- Gradual narrowing of spinal canal over years
- Arthritis, bone spurs, thickened ligaments, disc bulges
- More common after age 50
- Can be congenital (born with narrow canal) or acquired
How We Diagnose
Precise diagnosis guides treatment:
- Clinical examination: Neurological testing, provocative maneuvers, assessment of nerve root involvement
- MRI: Shows disc herniation, nerve compression, and canal narrowing
- CT scan: Better bone detail for stenosis evaluation
- X-rays: Weight-bearing views to assess alignment
- CT myelogram: When MRI cannot be performed or additional detail needed
Urgent evaluation needed for: Progressive weakness, loss of bowel/bladder control, or severe unrelenting pain not responding to treatment.
Treatment Options
Good News for Most Patients
The majority of spine conditions improve with conservative (non-surgical) treatment. Surgery is typically considered only when non-surgical approaches haven't provided adequate relief after an appropriate trial period, or when there are progressive neurological symptoms.
Non-Surgical Treatment (First-Line Approach)
- Targeted physical therapy and exercises
- Oral anti-inflammatory medications
- Epidural steroid injections (transforaminal or interlaminar)
- Nerve root blocks
- Activity modification and positioning strategies
- Short-term use of pain medications
- Traction therapy (select cases)
Surgical Options
- Microdiscectomy (minimally invasive disc removal)
- Laminectomy and decompression for stenosis
- Foraminotomy (nerve opening enlargement)
- Fusion when instability present
- Endoscopic procedures (select cases)
When Surgery Is Considered
- Persistent leg or arm pain despite 6-12 weeks of conservative care
- Progressive neurological deficits
- Severe stenosis limiting walking ability (neurogenic claudication)
- Failed response to targeted injections
- Clear correlation between imaging and symptoms
- Cauda equina syndrome (emergency)
Recovery & What to Expect
Immediate Post-Surgery (Week 1)
Walking encouraged immediately, most go home same day or next day, pain management, wound care
Early Recovery (Weeks 2-4)
Gradual increase in activity, avoid heavy lifting and bending, many return to light desk work
Active Rehabilitation (Weeks 4-8)
Physical therapy begins, core strengthening, progressive return to normal activities
Full Recovery (Months 2-4)
Most patients achieve maximum improvement, return to full activity including exercise
Frequently Asked Questions
For Referring Providers
Evaluation Approach
Detailed assessment including dermatomal mapping, strength testing, reflex examination, and correlation with MRI findings to determine exact level and nature of compression.
What to Send
Recent MRI (lumbar or cervical depending on symptoms), previous treatment records, injection reports if applicable, and any prior surgical records.