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  • wastate
    Post count: 5

    Dr. Corenman,

    I (43 yr old male) have Spinal stenosis in 3 areas of the Lumbar spine. They are listed as 12.8 – 10.5 – and 9.8. Mild degenerative disc dieses at l4/L5- L5/S1.

    Symptoms are 80%leg -20%back. Toes tingle (both sides) left leg calf pain- left buttock comes and goes. Does not seem to matter what position I am in or walking or standing.

    1. When does this become a issue that has to be operated on? Is there a certain diameter that makes sense and it must be operated on and what is that diameter.

    2. Is a operation inevitable at a person the age of 43.

    3. If I have these issues in the Lumbar region is it a given that I will have stenosis issues higher up?

    Thank you,

    Donald Corenman, MD, DC
    Post count: 8459

    You note three areas in the lumbar spine with spinal stenosis- most likely at L3-4, L4-5 and at L5-S1 (the three lowest segments of the lumbar spine).

    You note leg symptoms as the most intense and that there is no position that tends to be the worst (between walking and standing). I assume that either walking or standing cause symptoms and sitting, bending forward or lying down, especially in a fetal position relieve symptoms.

    These symptoms are typical for neurogenic claudication caused by spinal stenosis (see website under these topics). The diameter itself can have some bearing on the need for surgery but symptoms do too. If the canal is so tight that the nerves are being crushed, there is the possibility of the onset of arachnoiditis (see website). The appearance of the MRI with experienced eyes will be the most helpful to determine that possibility.

    I have many patients with spinal stenosis that continue to function well without surgery using epidurals and a flat back posturing program in physical therapy to avoid surgery. Admittedly, each year some of these individuals desire surgery but there are still some that I monitor each year that continue to do well without surgery.

    Stenosis in the cervical spine is occasionally associated with lumbar stenosis but it is in the range of 10%. Symptoms of cervical stenosis include myelopathy (check website for that information) and rarely, central cord syndrome.

    Dr. Corenman

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