Spinal Stenosis Treatment in Castle Rock
What is Spinal Stenosis?
Spinal stenosis is a condition in which the spaces within the spine narrow, putting pressure on the spinal cord and nerve roots. This narrowing can occur in the neck (cervical stenosis) or lower back (lumbar stenosis). Lumbar stenosis is far more common and is the type most frequently treated in a pain management setting.
Spinal stenosis is most commonly caused by degenerative changes related to aging - arthritis, disc degeneration, bone spurs, and thickening of the ligamentum flavum (the ligament along the back of the spinal canal) all contribute to gradual narrowing over time. Some people are born with a smaller spinal canal, which makes them more susceptible to developing symptomatic stenosis as they age.
What Does Spinal Stenosis Feel Like?
Lumbar stenosis (lower back):
Pain, heaviness, numbness, or tingling in the legs that is worse with standing and walking
Symptoms that improve when you sit down, lean forward, or push a shopping cart (flexion opens the spinal canal)
Gradually decreasing ability to walk long distances (neurogenic claudication)
Low back pain and stiffness
In severe cases, weakness in the legs or difficulty with balance
The hallmark of lumbar stenosis is neurogenic claudication - a pattern where leg symptoms get worse the longer you stand or walk and improve quickly when you sit or lean forward. This is different from vascular claudication (caused by poor circulation), which also causes leg pain with walking but is not relieved by leaning forward.
Cervical stenosis (neck):
Pain, numbness, or weakness in the arms and hands
Balance and coordination problems
In severe cases, difficulty with fine motor tasks (buttoning a shirt, writing) or gait changes
How is Spinal Stenosis Diagnosed?
Dr. Carrera's team evaluates stenosis through your history, physical and neurological examination, and imaging. An MRI is the most useful study because it shows the spinal canal, nerve roots, discs, facet joints, and ligamentum flavum. The team correlates the imaging findings with your symptoms to determine the severity and plan treatment.
How is Spinal Stenosis Treated?
Physical therapy: Flexion-based exercises, core stabilization, and aquatic therapy can improve mobility and reduce symptoms. Staying active is important - prolonged inactivity tends to make stenosis symptoms worse.
Medications: NSAIDs (meloxicam) for inflammation and nerve-calming medications (gabapentin, pregabalin) for nerve-related leg symptoms.
Epidural steroid injections: Interlaminar or caudal epidural injections deliver anti-inflammatory medication into the epidural space to reduce swelling around compressed nerves. These can provide meaningful relief and help patients maintain their walking ability. For stenosis affecting a single level or one side, a transforaminal epidural may be appropriate.
MILD (Minimally Invasive Lumbar Decompression): For patients with lumbar stenosis caused by thickened ligamentum flavum whose symptoms persist despite epidural injections, the MILD procedure removes the excess ligament tissue to create more space in the spinal canal. MILD is an outpatient procedure with no implant, no general anesthesia, and minimal recovery time. Published studies show significant improvement in standing time and walking distance.
Spinal cord stimulation: For patients with persistent nerve pain from stenosis that has not responded to injections or MILD, spinal cord stimulation can provide relief.
Surgery (laminectomy): Surgical decompression is considered for severe stenosis with progressive weakness, significant numbness, or symptoms that have not improved with non-surgical treatments. Dr. Carrera's team works closely with spine surgeons and will coordinate a referral when surgery is appropriate.
Schedule an Evaluation
If standing and walking are becoming more difficult due to leg pain or heaviness, spinal stenosis may be the cause. Dr. Carrera's team can evaluate your symptoms, review imaging, and determine the best treatment approach - from epidural injections to the MILD procedure to advanced options.