You head out for a walk on the beach or around the neighborhood feeling fine. Ten minutes in, your legs feel heavy, tired or numb, and you need to sit down or lean on something. After a few minutes on a bench it eases, and you can keep going. Over the months, the distance you can walk before that happens keeps getting shorter.
That pattern is one of the most common reasons people see a spine surgeon in Southwest Florida. It has a name, neurogenic claudication, and it usually points to lumbar spinal stenosis.
Here's what's going on, how it's diagnosed, and what can be done about it, from nonsurgical care to minimally invasive surgery with Dr. Nicholas Clark at HSS at NCH in Naples.
What spinal stenosis is
Spinal stenosis means the spaces in the spine that hold the nerves have become too narrow. When those spaces get crowded, the nerves get squeezed, and that can cause pain, numbness, heaviness or weakness in the legs.
Most stenosis comes from slow wear over many years:
Thickened ligaments inside the spinal canal
Arthritis in the facet joints, which can enlarge and crowd the nerves
Bulging or herniated discs
Bone spurs along the edges of the vertebrae
A slip, called spondylolisthesis, where one vertebra shifts forward over the one below it
A synovial cyst, a small fluid-filled sac from an arthritic joint that presses on a nerve
Why walking hurts and sitting helps
Standing up straight and walking narrows the spinal canal a little. Sitting or bending forward opens it back up. That's why many people with stenosis can walk farther in the grocery store when they lean on a shopping cart, or find a stationary bike easier than a walk.
Back pain is often part of the picture, but the leg symptoms are usually what limit daily life most. Stenosis can also pinch a single nerve root and send pain down one leg, which is called radiculopathy or sciatica.
Leg pain with walking isn't always the spine, though. Circulation problems in the legs, hip arthritis and nerve problems from diabetes can feel similar. Sorting that out is a big part of the first visit.
How stenosis is diagnosed
Diagnosis starts with your story and an exam: how far you can walk, which positions help or hurt, and whether there's weakness, numbness or a change in reflexes.
An MRI shows the narrowing, how tight it is and which nerves are being pressed. X-rays, including bending views, show alignment and whether a vertebra has slipped or moves too much, which can change the treatment plan.
Narrowing on an MRI is common as we age, and not all of it causes symptoms. The exam and the imaging have to match. Dr. Clark prefers that patients have an MRI and a course of physical therapy before the first visit when possible. Our post on what to expect at your first visit explains why.
Nonsurgical care comes first
For mild to moderate stenosis without worsening weakness, treatment starts without surgery:
Physical therapy focused on core strength, posture and positions that open the canal
Activity changes, such as pacing your walks, breaking up long periods of standing, and using a cart or a stationary bike
Medicines to calm pain and inflammation, when they're safe for you
Epidural steroid injections through a pain management specialist, which can calm irritated nerves and help show which level is causing symptoms
For many people, this keeps symptoms manageable for a long time. It's worth knowing that these treatments calm the nerves but don't widen the canal.
When surgery makes sense
Surgery may be worth discussing when:
Leg symptoms keep limiting walking, standing or daily activities despite good nonsurgical care
Weakness is getting worse
The imaging and exam clearly match your symptoms, so surgery is aimed at the real cause
You never have to decide on the spot. The goal is a plan that fits your spine and your life.
What stenosis surgery looks like
The main goal is decompression, which means removing the bone, ligament or disc material crowding the nerves.
Minimally invasive decompression (ULBD laminotomy/laminectomy). Through a small incision on one side of the back, using dilating tubes and a microscope, Dr. Clark removes enough bone and ligament to free both sides of the canal. When the spine is stable, this is usually not a fusion, and most people go home the same day when ready. You can read more on the MIS decompression page.
Fusion when there's a slip or instability. If a vertebra has slipped or the level moves too much, decompression alone may not be enough. An MIS TLIF takes pressure off the nerves and stabilizes the level so the bones can heal together over the following months. In selected cases, a lateral (LLIF) or anterior (ALIF) fusion may be a better fit. For fusions that need posterior screws, Dr. Clark uses the Globus ExcelsiusGPS robot at NCH to help place percutaneous posterior screws through small incisions with less x-ray. Learn more about robotic spine surgery.
Synovial cyst excision. When a cyst from an arthritic joint is the main problem, removing the cyst takes the pressure off the nerve.
A minimally invasive approach accomplishes the goals of traditional surgery, taking pressure off the nerves and stabilizing the spine when needed, with less disruption to the muscles.
What surgery can and can't do
Decompression is aimed at leg heaviness and walking limits. It doesn't cure arthritis, so some back pain from arthritic joints may remain. Leg pain tends to improve more reliably than numbness or weakness, and the nerves need time to settle after the pressure is gone. For many patients, the best measure of success is simple: how far you can walk.
Stenosis in the neck is different
Stenosis in the neck can press on the spinal cord itself. This is called myelopathy, and it can be painless. Warning signs include clumsy hands, trouble with buttons, dropping things and trouble with balance. Cord compression usually doesn't get better on its own, and when it's getting worse, it isn't a wait-and-see problem. Depending on the anatomy, treatment may be an ACDF or a cervical disc replacement.
When to get help right away
Go to the nearest emergency room or call 911 if you have new loss of bladder or bowel control, numbness in the groin or inner thighs, or leg weakness that is getting worse quickly.
Seeing Dr. Clark for spinal stenosis
Dr. Clark sees patients at HSS at NCH in Naples and cares for patients from Bonita Springs, Estero, Fort Myers, Marco Island and across Southwest Florida. If your walks keep getting shorter, call our team at (239) 624-0306.
This article is for general education and isn't medical advice. Talk to your doctor about your specific situation.
