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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Colleen Young, Connect Director | @colleenyoung | Apr 6 1:40pm

In reply to @rockinrene65 "@jenniferhunter Liv Hospital" + (show)

@rockinrene65, as per @jenniferhunter's request, I see you were trying to post a link to the information your shared. You will be able to add URLs to your posts in a few days. There is a brief period where new members can't post links. We do this to deter spammers and keep the community safe.

Allow me to post the link for you:
- 4 Stages of Slip Disc: Causes and Symptoms Explained https://int.livhospital.com/4-stages-of-slip-disc-causes-and-symptoms-explained/

jlssurplus | @jlssurplus | Apr 7 7:22am

In reply to @sue4 "@marietter - yes, on April 15 I’m having a 2-level endoscopic laminectomy by a Johns Hopkins..." + (show)

@sue4
I had a 3 level MILD done which is a little less invasive.

Surgery pain was really not much more than my presurgery sciatic pain, just in back instead of legs and at least pain meds helped unlike my sciatica

Was able to walk right away but pre surgery sciatic pain level didn't improve at all for 5 weeks.

You'll have PT, mine started at about 6 weeks I think. Yours might be longer.

Walking as tolerated is probably most important thing to do, I went from 2 days on walker as pain got worse after surgery, to a cane and then without anything.

I was allowed to drive as soon as off pain meds, a couple weeks for me.

Lifting restriction probably 8-10lbs.
Dog walking (just to back yard) at 3 weeks although surgeon wanted 6.
I would guess they will want you not to for 3 months. You can't be jerked around. Depends on your dog. Mine is 70lbs of shepard/lab who takes of after Turkey's ducks, rabbbits squirels Etc

Good luck with your surgery/recovery, I'm sure you will do fine

sue4 | @sue4 | Apr 7 1:06pm

In reply to @jlssurplus "@sue4 I had a 3 level MILD done which is a little less invasive. Surgery pain..." + (show)

@jlssurplus Thanks so much; that’s very helpful. My pup is a very chill 40 lbs dog & I’m hoping to walk her at 3 weeks (I bought a pooper-scooper). I’m in an in-house rehab the 1st week; then, my son is helping me with my dog for 2 more weeks. I hope that will work. Again, thanks.

ou14mejc | @ou14mejc | Apr 8 9:09am

In reply to @jpeach "I went to Pain Managenent Center to consult with the Neurologist who does the MILD procedure...." + (show)

@jpeach pain management also recommended the MILD procedure for me. I couldn’t find very many people who said it worked for them and surgeons really don’t like doing them, My neurosurgeon said it would make things more difficult for him when he did laminectomy/fusion surgery. I’m seeing a surgeon in July for the TOPS procedure. I have a slipped disc at L4-5 with severe stenosis. I’m trying to avoid a fusion.

jpeach | @jpeach | Apr 8 11:16am

In reply to @ou14mejc "@jpeach pain management also recommended the MILD procedure for me. I couldn’t find very many people..." + (show)

@ou14mejc
Thank you for your input.
I just came back from my appt with surgeon and I have to go on RX for osteoporosis for several months before he is willing to do a minimally invasive decompression, but I was shocked to find out it will still involve screws and a fusion. I have several months before I go back to digest everything. What is the TOPS procedure? I have a 70% narrowing in spinal canal. I can walk for 30-40 minutes if I push it.
Good luck with your procedure!

ou14mejc | @ou14mejc | Apr 8 2:24pm

In reply to @jpeach "@ou14mejc Thank you for your input. I just came back from my appt with surgeon and..." + (show)

@jpeach I have been on a daily injection of Forteo for two years now. If not, I probably wouldn’t be looking at surgery because of osteoporosis. I have moved into the osteopenia category after two years…Yay! I do not want a fusion, due to the stress above and below the fusion that will leads to more surgeries. The TOPS is a new surgery in the US that avoids a fusion and allows movement. It’s supposed to alleviate the stress above and below the fusion. It has been done in Europe 12 years or so, but was just approved here in 2023, so many doctors haven’t been trained to do it. You can look up TOPS spine surgery to find out more. Good luck to you as well. I’ve delayed surgery as long as I can. My ER visits are more frequent and I’m having trouble walking, standing and sitting.

jpeach | @jpeach | Apr 8 8:35pm

In reply to @ou14mejc "@jpeach I have been on a daily injection of Forteo for two years now. If not,..." + (show)

@ou14mejc
I just read about his TOPS device but the closest DR is 2 hrs away and it seems too new to find reviews and research about its effectiveness. I don't feel comfortable with an implant, but I am so happy you did move into the osteopenia category and can look into this. Best of LUCK!