Spinal Stenosis

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Duke's back doctors use advanced techniques to treat the progressive narrowing of the spine -- a condition known as spinal stenosis. Our goal is to avoid surgery, if possible. However, when surgery is necessary, our spine experts specialize in surgeries that reduce pain and improve other problems associated with stenosis. We help you preserve and potentially regain your normal function as quickly as possible.

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About Spinal Stenosis

Stenosis is most common in the lower back and neck. It can cause a range of symptoms including pain and numbness, difficulty walking, problems with bladder and bowel function, and weakness. We treat the full range of spine conditions, which is an important consideration because stenosis can be caused by degenerative disc disease, spinal arthritis, or trauma such as a spine fracture or spine cancer.

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Treatments for Spinal Stenosis

Spinal stenosis treatment often begins with nonsurgical options, with surgery as a later consideration.

Medications

Your doctor may recommend prescription medications to treat nerve damage caused by stenosis. A medication regimen may be coupled with physical therapy.

Physical Therapy

A trained physical therapist guides you in exercises and stretching designed to strengthen your back, improve your balance and flexibility, and increase your range of motion -- all outcomes that can alleviate your pain and the pressure on your nerves. Physical therapy may be recommended both before and after surgery.

Spine Injections

Epidural steroid injections treat inflammation and pain right at the source -- your nerve roots. Your doctor numbs your skin and places a needle into the epidural space in your spine, using X-rays to help guide the needle. You’ll feel pressure during this procedure. The medicine usually begins working within a few days to a week. You’ll be able to return to normal activities the following day. We give these injections in a special, sterile suite.

Alternative Treatments

During acupuncture, our acupuncturist uses fine needles placed strategically in your skin to relieve pain. Massage therapy manipulates muscles to relax them, ease tension, and improve blood flow and circulation. These treatments may be offered as a complement to your regular treatment plan, not as a substitute.

Lumbar Decompression Surgery

Decompression surgery relieves pain and pressure from pinched nerves by creating more room in the spinal canal. In some cases, minimally invasive lumbar decompression (or MILD) may be possible. This surgery is performed using general anesthesia and is made up of two parts. First, the affected lamina (back part of the vertebra) is removed in a procedure called a laminotomy or laminectomy. Next, the surgeon removes a small portion of the bone over the nerve root and possibly part of the disc under the nerve root -- these are called a foraminotomy and a microdiscectomy, respectively. Depending on how involved the surgery is, it can last for one or two hours. You may be able to go home the same day, or you might need to stay in the hospital for two or three nights.

Spinal Fusion

Usually reserved for people whose stenosis has caused instability in the spine, spinal fusion stabilizes the spine with rods and screws and fuses two or more vertebrae together. Whenever possible, we use the least-invasive techniques available so that you can recover faster and experience less pain and fewer complications.

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Tests for Spinal Stenosis

X-Ray

X-rays take pictures of bones and joints in your back. They can help identify fractures, tumors, dislocations, bone spurs, instability, or other potential causes of pain. This test takes about 15 minutes and is virtually painless. Because X-rays only show bones, and not discs or nerves, an additional imaging test may also be needed.

Magnetic Resonance Imaging (MRI)

Magnets and radio waves create detailed pictures of your spine, including your discs and nerves. Images can help identify disc damage or pinched nerves. This test takes about 30 to 60 minutes,and is virtually painless.

Computed Tomography (CT)

A series of cross-sectional pictures produce detailed, 3D images of your spine and spinal cord. This test takes about 30 to 60 minutes and is virtually painless.

CT Myelogram

A dye is injected into the sac around the nerve roots in your spinal cord to make them more visible on a CT scan. This test is often used for people who are unable to get an MRI. You will feel some discomfort during the injection. This test takes about one or two hours.

Electromyogram (EMG) / Nerve Conduction Study (NCS)

Electrodes are inserted directly into muscle with a thin needle to record electrical activity. You will feel some discomfort. EMG and NCS, which can last from 30 to 90 minutes, measures how well muscles and nerve cells are working in a certain area of your body -- in this case, your back or neck.

Best Hospital for Orthopaedics, Neurosurgery in NC

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our orthopaedics, neurology, and neurosurgery programs are nationally ranked, and are the highest ranked programs in North Carolina, according to U.S. News & World Report for 2023–2024.

Why Choose Duke

Highly Experienced Spine Center
Research shows that hospitals and surgeons who perform more surgeries tend to have better outcomes. Our surgical team performs more than 3,000 spine surgeries every year and sees over 30,000 patients.

Minimally Invasive Spine Surgeries
Whenever possible, we use advanced minimally invasive procedures. Using high-powered microscopes and tiny instruments, surgeons can access the spine through small incisions. This technique limits muscle damage, results in less pain, and helps you recover faster.

Operating Room Technology
Our ORs are equipped with real-time imaging options that give spine surgeons detailed, 3D pictures and video of your spine. These systems can decrease the need for extra imaging after surgery, exposing you to less radiation. OR staff also use a sophisticated sensor navigation system that helps them avoid vital nerves and other structures. This allows for more surgical accuracy than ever before.

A Team of Specialists
In addition to neurosurgeons and orthopaedic surgeons, your team may include physiatrists (physical medicine and rehabilitation doctors who specialize in conservative spine care), physical therapists, psychologists, pain management experts, and others -- all of whom work with you to alleviate the pain caused by your stenosis or myelopathy.

This page was medically reviewed on 10/13/2022 by

Oren N. Gottfried, MD | Neurosurgeon