Any realistic alternatives to surgery for severe lumbar stenosis?

Posted by heycal @heycal, Feb 20 6:32pm

63 year old male with various older guy health issues but otherwise fit and active (weights, softball, tennis, walking). Had some left buttock pain in summer '24 at the very beginning of activity but went away. Fall 2025 it came back more regularly and it became more painful and disabling and sometimes including sensations down the left leg.

Finally diagnosed via MRI as severe stenosis at L4/L5 with some disc slippage or whatever to boot. Orthopedist said I likely need surgery and sent me to spine surgeon. Surgeon said I likely did, but could first try an epidural injection and perhaps some PT. Epidural injection provided a moderate amount of relief for about 3 weeks, then back to living on advil. Surgeon said laminectomy with spinal fusion is next step whenever I'm ready for it. (Haven't tried PT since both surgeon and epidural doc said it wasn't going to truly fix anything and I've always hated PT anyway, but did schedule an appointment for that too.)

Like most people, I don't want spine surgery, particularly any that includes "spinal fusion". Do I have any real alternatives here?

I'm read about somethigng called MILD and other versions of minimally invasive procedures but don't know if they are legit or not, and if they are, if my particular condition could be fixed that way. I've scheduled both a second opinion with a regular surgeon and at two other places that supposedly offer the MILD type procedures.

Anyone with any experience with any of the above, please share your thoughts. Thanks.

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heycal | @heycal | Apr 2 3:50pm

In reply to @genegro "@loriesco Thank you for the feedback. I believe two back surgeons said that I wasn’t a..." + (show)

@genegro You'd rather have doctors cut open your back to perform surgery via laminectomy and/or spinal fusion instead of having to "worry" about any more shots? I'd be a lot less worried about injections than I would be about whether my surgery and recovery went smoothly.

I myself had an epidural that didn't really do much and will try another for the heck of it, but I'd be thrilled to have gotten 7 months relief and would gladly do that twice a year until the day I died, particularly if at least two doctors were telling me to do so. I found the injection to be literally easier and faster than a dental cleaning. Did you have a different experience with it?

cori | @ccchang | Apr 3 1:13am

In reply to @loriesco "@ccchang UCSD - Dr. Zlomislec. But any ortho spine surgeon there is awesome!" + (show)

@loriesco Thank you! You're lucky to live close to UCSD!

loriesco | @loriesco | Apr 3 9:30am

In reply to @ccchang "@loriesco Thank you! You're lucky to live close to UCSD!" + (show)

@ccchang I am pretty lucky to live 30 minutes to an hour away. Some people drive four or five hours to see Dr. Z. And then we have to wait if he has an emergency surgery or obstacle. I am grateful.

jpeach | @jpeach | Apr 3 11:45am

I went to Pain Managenent Center to consult with the Neurologist who does the MILD procedure.
He told me that he has only seen 50% of people have an improvement with that procedure, but he doesn't do too many . I don't qualify because the people who get it can only walk 300 ft and need to lean on a shopping cart to get around the grocery store.
I told him I can walk 2 miles, but with pain for the first 15 minutes. ( MRI severe LS at L4L5.
Taking Tylenol advil and small dose of tramadol. Epidural steroid a few weeks ago didn't help.
He suggested Cymbalta or Pregabalin for neuopathy,
But have read about so many side effects.

Mariette R. | @marietter | Apr 4 8:27am

See a neurosurgeon who performs Endoscopic spine surgery for a consult. No fusion, no hardware and easy recovery time.

Rene' | @rockinrene65 | Apr 5 2:29am

The 4 Stages of Disc Herniation
Stage 1: Disc Degeneration (Bulging)
Description: The outer layer of the disc (annulus fibrosus) weakens, often due to aging, wear and tear, or chemical changes.
Structure: The inner core (nucleus pulposus) remains inside, but the disc begins to lose hydration and height, leading to a "bulge" where the disc extends beyond its normal margin.
Symptoms: Usually mild pain or localized back stiffness.
Stage 2: Prolapse (Protrusion)
Description: The inner nucleus pushes further against the outer annulus, causing a distinct, more pronounced bulge.
Structure: The protrusion pushes against the outer layer, sometimes touching nearby nerves, but the annulus fibers are not completely broken.
Symptoms: Localized pain or slight radiating discomfort/tingling.

Stage 3: Extrusion
Description: The nucleus breaks through the outer annulus fibers.
Structure: The inner gel-like material leaks out of the disc but remains attached to it, often pushing significantly into the spinal canal.
Symptoms: High chance of severe, radiating pain (sciatica), numbness, or weakness due to direct nerve pressure.

Stage 4: Sequestration (Sequestered Disc)
Description: The most severe stage, where the extruded nucleus breaks off and separates entirely from the disc, migrating into the spinal canal.
Structure: Fragments of the nucleus material are detached, often causing severe inflammation and high-level irritation.
Symptoms: Intense, severe radiating pain, significant mobility issues, and potential serious neurological deficits.
+8
Key Takeaways
Healing: Stages 1 and 2 are considered "incomplete" herniations and often respond to conservative treatments like physical therapy and medication.
Emergency: Stage 4 (Sequestration) can cause cauda equina syndrome, requiring immediate medical care, especially if symptoms include loss of bladder/bowel control.
Diagnosis: MRI findings and physical exams are used to determine the stage.

Source: https://int.livhospital.com/4-stages-of-slip-disc-causes-and-symptoms-explained/

sue4 | @sue4 | Apr 5 5:50am

In reply to @marietter "See a neurosurgeon who performs Endoscopic spine surgery for a consult. No fusion, no hardware and..." + (show)

@marietter - yes, on April 15 I’m having a 2-level endoscopic laminectomy by a Johns Hopkins neurosurgeon. What can I expect in recovery, PT or just walking, pain meds, rehab, time until I can drive, walk my dog, etc. thank you.

Mariette R. | @marietter | Apr 5 7:01am

All important questions to ask your surgeon and/or clinical team before your procedure . Don’t be afraid to have this discussion.

Jennifer, Volunteer Mentor | @jenniferhunter | Apr 6 10:26am

In reply to @rockinrene65 "The 4 Stages of Disc Herniation Stage 1: Disc Degeneration (Bulging) Description: The outer layer of..." + (show)

@rockinrene65

Source: https://int.livhospital.com/4-stages-of-slip-disc-causes-and-symptoms-explained/

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@rockinrene65 That is a lot of great information and detail about spinal discs. It would be helpful if you could share the source of the information you posted or a link. If you are a new member, you can ask a moderator to share it for you.

Are you a spine patient and trying to navigate a path in your care or assisting someone with treatment? I almost forgot, welcome to Connect. I am a cervical spine surgery patient and 10 years past my surgery.