What it is
Spinal stenosis is a narrowing of the spinal canal or the openings where nerves exit, placing pressure on nerves or the spinal cord. In the lumbar spine it classically causes leg heaviness, aching, or numbness with walking that eases when you sit or lean forward — the shopping-cart sign. In the neck, stenosis can compress the spinal cord itself (myelopathy), affecting hand function and balance.
Common symptoms
- Leg heaviness, aching, or numbness that builds with walking or standing
- Relief with sitting or leaning forward (on a cart, counter, or walker)
- Progressively shorter walking tolerance
- In cervical stenosis: hand clumsiness, balance difficulty, coordination changes
Why it happens
Stenosis is usually degenerative — thickened ligaments, arthritic facet joints, bulging discs, and bone spurs gradually narrowing the canal over years. It most often becomes symptomatic after age 60. It rarely improves on its own, but symptoms can often be managed well without surgery for years.
How Dr. Pompliano evaluates it
Every evaluation starts with listening — a detailed history of your symptoms, how they behave, and how they limit your life — followed by a focused physical and neurological examination and a careful review of your imaging. The diagnosis drives the plan, not the other way around.
Treatment: conservative first
Most patients with this condition improve without surgery. Depending on your specific situation, a plan may include:
- Physical therapy: flexion-based conditioning and endurance work that expands what you can comfortably do
- Activity strategies: smart pacing and positioning that maintain fitness within your comfortable range
- Medication: purposeful, time-limited use where appropriate
- Epidural injections: can provide meaningful windows of relief, particularly for radiating leg symptoms
Surgery is recommended only when symptoms persist despite a genuine course of conservative care, or when there are signs of progressive nerve or spinal cord compromise.
When surgery makes sense
When stenosis steadily shrinks your world — walking tolerance falling, independence narrowing — decompression surgery reliably reopens the space around the nerves, often minimally invasively. If instability or slippage accompanies the narrowing, a fusion may be added at that level. Cervical myelopathy is treated with more urgency, as timing affects outcome.
Related procedures: Decompression / Laminectomy · TLIF · ACDF