Overview
Spinal stenosis occurs when the spaces within the spine narrow, compressing the spinal cord or nerve roots. This compression causes pain, numbness, tingling, and weakness — most commonly in the lower back, buttocks, and legs (lumbar stenosis) or the neck, shoulders, and arms (cervical stenosis). It is most common in adults over 50 and often progresses gradually. Dr. Migdale is fellowship-trained in the full range of interventional options for spinal stenosis, from epidural steroid injections to advanced minimally invasive procedures.
Understanding Spinal Stenosis
The spine's vertebral canal and foramina (openings through which nerve roots exit) can narrow due to age-related changes including thickening of ligaments, bone spur formation (osteophytes), disc bulging or herniation, and facet joint enlargement. This narrowing compresses neural structures, producing characteristic symptoms: pain or cramping in the legs with walking that eases with sitting or bending forward (neurogenic claudication), and often persistent aching in the back or neck.
Diagnosis and Evaluation
Diagnosis of spinal stenosis typically involves a combination of clinical examination and imaging — most commonly MRI, which directly visualizes the degree of canal narrowing and nerve compression. Dr. Migdale reviews imaging carefully and correlates findings with the patient's symptoms to determine the level(s) involved and the most appropriate treatment approach.
Non-Surgical Treatment Options
Many patients with spinal stenosis achieve significant relief without surgery. Dr. Migdale offers epidural steroid injections to reduce nerve inflammation and provide sustained relief; image-guided procedures targeting specific levels of stenosis; and, for patients with refractory symptoms, minimally invasive procedures such as the mild® procedure for lumbar spinal stenosis, which uses a specialized instrument to remove excess tissue causing compression. Neuromodulation is also an option for patients who have not responded to other treatments.