r/SpinalStenosis

My bf 33M was in a traumatic accident just over two years ago. He had some fractures throughout his cervical and thoracic spine. He ended up having a ACDF C4/C5 and he has been dealing with SEVERE chronic pain since. Once he started this current medication regimen, the pain has been more manageable but still severe. At times, he has what we refer to as “flare ups” where the pain becomes debilitating. Some flares result in his entire body feeling bruised (he describes as feeling as though he were beat with a baseball bat all over) and he will get acute head pain which he describes as being behind his eyes. When these flares happen, he often gets nauseous and it becomes nearly impossible for him to function at all.

Medication management:
Meloxicam (NSAID)
Tramadol (weaned from Oxy to this after a year)
Lyrica 150mg 3x daily (currently trying to wean, was previously on gabapentin)
Amitriptyline 50mg
Hydroxyzine as needed
Tylenol as needed
He’s tried muscle relaxers which he felt did not do much
Topicals (Voltaren, pain patches, etc)

He sees a chiropractor weekly which he finds relief in very briefly
He’s seen physical therapists
Has tried acupuncture and a steroid injection once
Heat therapy brings some relief

Does anyone else have flares that are extremely severe, debilitating and last anywhere from an hour to multiple hours?

Aside from the horrendous flare ups, he is always in severe, but manageable pain. We have researched a lot but I’m desperate to finally find something that will truly give him a break from the constant pain. Any advice would be great!

I’ll try to make my long story short :)

I have an MRI booked for next month to confirm, but the doctor at the hospital wrote on the paper for physio “spinal stenosis/bilateral sciatica “.

Both of my legs have the most intense uncomfortable buzzing that is there 24 hours a day (even wakes me from sleep). It is down the front of my legs.

My lower back always hurts and there is a tender spot.

I cannot make it to a minute of standing or walking without the buzzing firing up and feeling like my legs are going to give out from under me.
I have had to borrow a rollator from a neighbour that allows me to walk a few steps and then sit.

Prior to all of this I was athletic and at the gym 5 days a week.

My first physio appointment was yesterday and after her testing and evaluation, she called me a severe case.

I can’t walk, stand, and I don’t sleep anymore.

I feel like the nerve pain is even worse today after physio.

Should I continue physio or do nothing until after my mri?

Hi everyone. I have degenerative disk disease, spinal stenosis, osteophytes and a congenitally narrow spinal opening. I also have knee arthritis. I have knee pain and now having fasciculations in my calf muscles on the knee pain side (right) and my right calf is an inch smaller than my left. Spine Doctor said take care of the knee first because its too hard to tell exactly which spinal nerve is causing me problems. Knee Doctor says to have knee replacement. But it appears they don't communicate even though they work from the same ortho office. The fasciculations are new.

I feel like I need a team to work together to look at both my leg and my back or I am never going to get the help I need. Does anyone have any suggestions that might help? I'm 58 years old.

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I am having surgery to correct cervical stenosis and bone spurs that are putting pressure on my spinal cord.

I have spastic quadrapelgic/ right hemiplegic cerebral palsy. This causes my neck to pull my head to the right.

My surgery is scheduled for 8am this morning.

I am somewhat nervous because of the stakes involved. My surgeon is the top neurosurgeon in my city and likely the country.

Has anyone else had this surgery? With or without cerebral palsy.

I want to know what i am getting myself into.

Doctor said I probably have spinal stenosis and ordered X-rays. Did anyone actually have anything show on an X-ray? I was told only an MRI or CT would actually show anything for that.

Hi everyone, I'm a neurosurgeon. I've been getting a steady stream of DMs asking some version of the same question: My surgeon offered a minimally invasive discectomy, but I have read/heard about endoscopic discectomy. Which is better? What's the difference? 

It comes up enough that it deserves its own post, figured I'd write about this on my flight.

First, the reason everyone is confused,  these two terms are not the same kind of word.

"Minimally invasive spine surgery" (MIS) is a category. It's an umbrella term for any approach that gets to the spine while cutting through as little muscle as possible. It describes a goal, not a specific tool or approach or technique. "Endoscopic" is a minimally invasive technique. It's one specific way of achieving the goal of addressing your spine pathology. In other words, endoscopic surgery is a variant of minimally invasive surgery. When a clinic advertises "endoscopic, not just minimally invasive," they are trying to highlight the fact that their surgeons are capable of performing endoscopic surgery, and differentiate themselves from other surgeons. That's just mostly marketing and I'll get into the reasons why later. But the gist of it is that endoscopy is still a relatively new approach and a smaller percentage of surgeons have specific training on that approach so they try to market that fact as a differentiator. For the record I also perform endoscopic surgery and I am not biased one way or the other. 

I will explain the difference between the open, the "MIS", and endoscopic approaches when it comes to a discectomy because that's the most common and easiest to understand. But much more can be accomplished by all the different techniques/approaches. In practice, most patients hear "MIS" to mean the tube-and-microscope version, so I'll use it that way below. 

The three approaches, from most to least tissue disruption. 

1. Open surgery. A longer incision. The muscle is peeled off the bone and held back with retractors so the surgeon can see the spine directly with their own eyes.

 

Incision size for a discectomy:  1.5- 2 inches (4-6 cm)

2. MIS (tubular / microscope). Instead of peeling muscle off bone, the surgeon uses a series of progressively larger dilators to spread the muscle fibers apart, then parks a tube (a "tubular retractor") down that channel. Everything happens through the tube. The surgeon looks down into it using an operating microscope, which sits outside the body and provides light and magnification. At the end, the tube comes out and the muscle springs back into place. X-ray (fluoroscopy) guides where to put the tube.

Incision size for a discectomy: ~ 0.6-0.8 inches (1.6-2 cm) 

3. Endoscopic. Same basic idea, but instead of looking down a tube from outside, the camera goes inside on the tip of the endoscope, right next to the tissue being worked on. Essentially still a tube but less than half the diameter with a camera at the tip and a small working channel where instruments can be passed through to do the work near the tip of the tube where the camera is looking.  Incisions are smaller, often around 1 cm or two roughly 7 mm openings. The work is usually done with continuous saline flowing through to keep the view clear and control bleeding. Two flavors of endoscopic, because this trips people up too:

 

-Uniportal (also called full-endoscopic). One incision. The camera and the instruments share a single working channel. Sub-types you'll see advertised: transforaminal (comes in from the side, through the natural window where the nerve exits) and interlaminar (comes in from the back, through the gap between the bones).

-Biportal (UBE, unilateral biportal endoscopic). Two small incisions. The camera goes in one, the instruments go in the other. Because they aren't fighting for the same channel, the surgeon has more room to maneuver and a wider working view. Costs you one extra tiny incision.

Neither is universally better. They're different tradeoffs.

What the evidence actually says for a discectomy:

This is the operation most of you are asking about: a piece of disc is pressing on a nerve, and it needs to be decompressed. 

The best single study here is a Dutch trial that randomized 613 people with sciatica to either transforaminal endoscopic discectomy or open microdiscectomy. At one year, endoscopic was non-inferior, meaning it was not worse. It actually edged ahead slightly on leg pain, back pain, function, and quality of life, with less blood loss, shorter hospital stays, and earlier walking. Repeat surgery within a year was 5% for endoscopic and 6% for the comparison group.

Here's the key part though: the authors themselves said the differences were small and might not be big enough for a patient to notice. (BMJ, 2022)

A 2026 meta-analysis pooling the randomized trials landed in the same place: comparable decompression and comparable patient-reported outcomes, less wound-related trouble with endoscopic, possibly faster return to work, but more X-ray exposure during the operation and no consistent long-term advantage in pain or disability. (summary here)

What this all means for you: for a straightforward disc herniation, both work. Endoscopic tends to win on the first few weeks. By a year out, you generally can't tell them apart from the outcome data. Let your surgeon choose the approach that works best in their hands. 

What about decompression for spinal stenosis?

Same story with a slightly different accent. Endoscopic decompression for lumbar stenosis achieves equivalent opening of the canal with less postoperative pain and faster mobilization compared with microscopic or open approaches. (review, Spine Journal meta-analysis)

The genuinely interesting use case is people who are borderline for anesthesia. Some endoscopic decompressions can be done with lighter sedation rather than full general anesthesia, which occasionally makes surgery possible for someone who was told they were too high-risk to operate on. There are published cases of this in patients in their nineties. (case reports, mostly) 

When endoscopic can be an option in my opinion: 

A single herniated disc, especially one sitting far out to the side (foraminal or extraforaminal), where the transforaminal endoscopic angle reaches it without removing bone that a posterior approach would need to remove

Focused stenosis at one or two levels

You have significant medical problems that make general anesthesia risky

Your priority is getting back to work fast and the pathology is simple

When it isn't

Your spine is unstable, or you have a slip (spondylolisthesis) that needs to be held in place. Decompression alone can make an unstable spine worse. That's a fusion conversation, not a technique conversation.

Deformity, scoliosis, tumor, infection, or fracture

Severe multi-level stenosis where a small working corridor isn't enough

Revision surgery through old scar tissue, where landmarks are distorted and a narrow view is a real disadvantage

You need a fusion. Endoscopic fusion exists, but the small working channel limits cage size, which limits fusion surface area and how much alignment can be corrected. (review)

If you take one thing from this post, take this: 

Endoscopic spine surgery has a steep learning curve, and the data on that is not subtle. One study suggested an experienced, traditionally trained spine surgeon needs roughly 15 endoscopic lumbar decompressions before getting through the initial curve, with higher complication rates in those early cases. For endoscopic fusion it's considerably more, in the range of 31 to 35 cases. (learning curve review, predictors of failure during the curve)

Even in that big Dutch trial, two of the surgeons who were still learning the endoscopic technique had noticeably higher reoperation rates than the experienced surgeon or the microdiscectomy group.

So: an experienced microdiscectomy surgeon beats an inexperienced endoscopic surgeon, every single time. The technique is not the variable that determines your outcome. The person holding it is. A surgeon who has done 800 tubular microdiscectomies and offers you one is not giving you the outdated option. They are giving you the one they are excellent at.

What to actually ask at your appointment

What exactly is compressing the nerve, and where is it (central, lateral recess, foraminal, far lateral)?

Which approaches are reasonable for my specific anatomy, and why do you prefer the one you're recommending?

How many of these have you personally done, and how many in the last year?

What's your reoperation rate for this procedure?

What happens if I wait?

Question 4 is the one people feel rude asking. Ask it anyway. Any good surgeon will answer it without flinching.

SOURCES:

AAOS OrthoInfo, Minimally Invasive Spine Surgery: https://orthoinfo.aaos.org/en/treatment/minimally-invasive-spine-surgery/

AANS, Minimally Invasive Spine Surgery: https://www.aans.org/patients/conditions-treatments/minimally-invasive-spine-surgery/

Gadjradj et al., Full endoscopic versus open discectomy for sciatica, BMJ 2022: https://pubmed.ncbi.nlm.nih.gov/35190388/

Meta-analysis of RCTs, full endoscopic vs microscopic lumbar discectomy (2026): https://painresearchforum.org/paper/full-endoscopic-versus-microscopic-lumbar-discectomy-for-lumbar-disc-herniation-a-meta-analysis-of-randomized-controlled-trials

Full-endoscopic vs microscopic decompression for lumbar stenosis, The Spine Journal: https://www.thespinejournalonline.com/article/S1529-9430(24)00005-6/abstract

Endoscope-assisted spine surgery, comprehensive review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12285748/

Learning curves in minimally invasive spine techniques, Neurospine: https://www.e-neurospine.org/journal/view.php?doi=10.14245%2Fns.2448838.419

Predictors of clinical failure during the endoscopic learning curve: https://www.sciencedirect.com/science/article/abs/pii/S1878875023017011

Advances in endoscopic lumbar spine surgery (fusion limitations): https://www.sciencedirect.com/science/article/abs/pii/S152994302500302X

Endoscopic decompression in a geriatric high-anesthetic-risk patient: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573698/

I suffer from a left foot numbness all the time. And I scan the MRI and X ray. Everything looks good only an articulation or fusion of the L5 transverse process with the sacrum. I eat medicines but it looks no change. And I also book an appointment about injections and waiting for it.

I don’t know whether the injections is useful for me?

The final option is surgery but it looks like this surgery is rarely. I would like to know who has similar situation.

Because I think it influences my life significantly I really want to solve it.

Seeking advice about which VA locations have the best spinal care and is it anyway the Va a would help with travel there I’m p&t and in a lot of pain

Folks,

It’s has been a while since I last asked a question so here it goes.

A discectomy L4 went real bad 4 years ago, sepsis, vertebrae resection, etc. bad bad pain. Been on an extended release med with immediate release available as well as the usual suspects.

Well I need C7 T1 at minimum stabilized. Doc says I am in for “hell” because they will not be able to control the pain. PT is going to cut meds by 30% next month to get ready.

This just does not feel right to me. Oh yea and they will approach from the back.

Hey everybody. Last year I was diagnosed with spinal stenosis. Insurance has denied MRIs and any pain relief. My dr hasn’t really delved further into after the insurance denial. He just kept recommending a breast reduction - but because I was recently postpartum and breastfeeding, it was not an option. I have recently lost my insurance so I feel like I’m kinda stuck. There are some days where the pain is so intense I just want to lay in bed and cry (obviously not possible with small children). I’ve been taking aspirin but it’s not touching the pain. What are some OTC options for me to get through this until I can get back on insurance?

I met with my neurosurgeon today and I’m set for October 5th 2 level ACDF of C5-C7. He said I have a higher chance of being paralyzed from the surgery since my neck is so bad, but he’s confident. I’ll have to stay the night in the hospital for the night to be monitored. I have to stop smoking tobacco or he won’t do it, so I’m quitting today.

How was your ACDF? I’m terrified. It needs to be done though so I’m trying to stay positive!

Getting tossed around from doctor to doctor, I was recently diagnosed with severe cervical stenosis, I’ve been having in and off burning nerve pain, neck pain, tingling and pin pricks and an overall heaviness, pm and r did an emg , which came back as fine so now….. instead of getting physical therapy….. or getting my neurosurgeon referral despite the findings of my mri, I’m being sent to a neurologist in 5 months……. It’s like they don’t believe me even though I went like 6 days without sleeping bec of the pain I was in.

I'm 70 F, very lucky to have been an active and healthy, pain-free person all my life. About a year ago pain started in my right lower back with intermittent radiation down my leg (tingling and numbness no pain below the lower back). I've now had an MRI and EMG and the last step is an extension/flexion x-ray which I'm getting today (to determine if the area, which includes a slipped disc, is unstable). Severe stenosis at L4 L5 is the diagnosis. The pain is manageable during the day but it keeps me up at night--I wake up every single time I turn in bed. I remain active and am in good physical condition.

The spine surgeon is a highly regarded MD with a great success rate. At my appointment yesterday, he said the likely best and "most durable" option for me is fusion, based on my symptoms and in his opinion probable instability in the area which would rule out less invasive options.

But is it? Is a minimally invasive procedure such as decompression or endoscopic surgery really not possible if there is "instability" in the area?

After reading about the length of recovery and rehab from a fusion surgery I am very reluctant to get such invasive, serious surgery.

I'd be grateful for any opinions on this from the community!

I have mild lumbar stenosis which has left me in awkward place of no one can help me further but I have had zero moments without pain since April 2024. I am only 30 though and NEED to find more ways to continue being everyday active that also puts less wear on my body.

I am starting to consider uses a cane or even a walker but am feeling a bit embarrassed still I suppose. Does anyone have success switching to using those items to help give me some hope?

Additional info on my situation:

I have tried (and they did not work):
-injections
-radio frequency ablation
-chiropractor
-massage

Strengthening through PT and other exercise has been helpful to ease flare ups but is very slow and minimal

Dry needling only helps the residual muscle pain

Full left side of the body weakness compared to the right

I’ve lost 50 lbs (I am a female with a large chest though)

Currently labeled as suspected EDS patient (I suspect POTS/MCAS in the mix as well)