What does stenosis feel like?
Lumbar (low back) stenosis often causes pain, tingling, or tired, heavy legs during standing or walking that eases when you sit down or lean forward — for example, leaning on a shopping cart. Symptoms usually develop slowly with age-related changes such as thickened ligaments, arthritis, and disc bulging.
A range of treatment options
Treatment usually starts with conservative care such as activity changes, physical therapy, and medication. Epidural steroid injections can calm irritated nerves. When symptoms keep limiting your day, minimally invasive procedures may be options for carefully selected patients.
MILD® (minimally invasive lumbar decompression)
MILD is one of the procedures we perform most often for lumbar spinal stenosis. A common cause of stenosis is a ligament in the back of the spinal canal (the ligamentum flavum) that thickens over time. During MILD, the physician uses X-ray guidance and small instruments placed through a tiny opening in the skin to remove small pieces of that thickened ligament, creating more room for the nerves. No implant is left behind and stitches are usually not needed. It is generally performed as an outpatient procedure with local anesthetic and light sedation.
Minimally invasive interspinous fusion: Minuteman® and Aurora Spine ZIP™
Some patients have stenosis together with wear or slipping between two vertebrae (degenerative disc disease or spondylolisthesis). For selected patients, a small implant can be placed between and attached to the spinous processes — the bony points you can feel along the back of your spine — to stabilize that level. The implant is packed with bone graft material so that, over time, the two vertebrae fuse (grow together) at that single level. These devices are FDA-cleared for use in the lumbar spine for conditions that include lumbar spinal stenosis, degenerative disc disease, and spondylolisthesis.
- Minuteman® (Spinal Simplicity) is an interspinous–interlaminar fusion plate placed through a small incision. It can be inserted from the side (a lateral approach) under X-ray guidance, which is designed to limit disruption of the back muscles.
- ZIP™ (Aurora Spine) is an interspinous fusion system with locking plates that grip the spinous processes. It is placed through a small incision and serves as supplemental fixation alongside bone graft to support fusion.
Because these implants are designed to create a permanent fusion, they are a bigger step than MILD. Your physician will explain how they compare with other options, including surgery by a spine surgeon, and what recovery typically involves.
Are you a candidate?
Not everyone with stenosis is right for these procedures. Your provider will review your symptoms, exam, and MRI or CT images (and sometimes X-rays taken while bending) and talk with you about which option — if any — makes sense, along with the expected recovery, risks, and alternatives, including referral to a spine surgeon when appropriate. Insurance coverage varies by procedure and plan; our office can help check.
Preparing for a procedure
- Tell us about every medication you take, especially blood thinners (for example warfarin, apixaban, clopidogrel, or daily aspirin). Do not stop a blood thinner on your own — we will coordinate with the doctor who prescribes it.
- Let us know if you have diabetes, an allergy to contrast dye, iodine, latex, or local anesthetics, or if you may be pregnant.
- If you will receive sedation, plan on having an adult drive you home.
- Call us if you develop a fever or infection before your procedure date.
Risks
All procedures carry some risk. Depending on the treatment, possible risks can include soreness or bruising where the needle was placed, bleeding, infection, a temporary rise in pain, allergic reaction to a medication, and, rarely, nerve injury. If a steroid is used, some people notice short-term flushing, trouble sleeping, or higher blood sugar. Your provider will go over the specific risks, benefits, and alternatives for your situation before you decide.
Implant procedures also carry risks such as the implant moving or loosening, fracture of the spinous process, the fusion not healing, and the need for additional surgery.
Exercises you can do at home
Staying active is an important part of most pain treatment plans. See our low back (lumbar) exercises for gentle stretches and strengthening options in lying, seated, and standing positions. Please ask your provider before starting, especially after a procedure.
This page is for general education and is not a substitute for an evaluation by a medical professional. Results vary, and no treatment works for everyone. Your provider will discuss whether this option is appropriate for you, along with its benefits, risks, and alternatives. Insurance coverage varies by plan — please call to verify.