Spinal stenosis is one of the most common reasons people over 50 see a spine surgeon. It means the space around the nerves has narrowed, usually from thickened ligaments, bone spurs and worn joints. The result is often leg pain, heaviness or numbness that gets worse with standing or walking and eases when you sit or lean forward.

For many years, surgery for stenosis meant a larger open operation, and sometimes a fusion. Today, endoscopic spine surgery gives some patients a smaller option.

What is endoscopic spine surgery?

Endoscopic surgery uses a thin tube with a high-definition camera, placed through an incision usually under half an inch. The surgeon removes the bone spur, thickened ligament or disc material that is pressing on the nerve, while gently moving muscles aside instead of cutting them away. Most patients walk the same day and go home the same day.

Who may be a good candidate?

Endoscopic decompression may be an option if you have:

• Leg pain, numbness or heaviness from stenosis at one or two levels
• Pain that has not improved enough with physical therapy, medicine or injections
• A spine that is stable on X-rays taken while bending forward and backward

Age alone does not rule it out. Many active adults in their 60s, 70s and beyond are good candidates, because the surgery is smaller and recovery is usually quicker.

When is a fusion still the better choice?

Endoscopic surgery is not right for everyone. A fusion, or another stabilizing procedure, may be the better choice when:

• One vertebra has slipped forward and moves when you bend (unstable spondylolisthesis)
• Freeing the nerve would mean removing so much of the joint that the spine could become loose
• There is a curve in the spine (scoliosis) or narrowing at several levels

For some patients, motion-preserving options such as facet replacement may also be worth discussing. The right choice depends on your MRI, your X-rays, your symptoms and your goals.

Where do injections fit in?

Epidural injections and other pain management treatments help many people with stenosis, and your pain management doctor is an important part of your care team. If injections have helped but relief is getting shorter, or you are not able to walk as far as you would like, it may be a good time to ask whether a surgical option makes sense. Seeing a surgeon does not mean you need surgery.

What is recovery like?

Every patient is different, but after endoscopic decompression many people:

• Walk the same day and go home the same day
• Return to desk work in about 1 to 2 weeks
• Start physical therapy within a few weeks
• Get back to golf, walking and other activities over the following weeks, as their surgeon allows

Frequently asked questions

Is endoscopic surgery the same as laser spine surgery?

No. Endoscopic surgery uses a camera and small instruments to remove what is pressing on the nerve. It is a standard, well-studied technique.

Will I need a fusion later?

Most patients who are good candidates for endoscopic decompression do not need a fusion later. Your surgeon can explain your own risk based on your X-rays and MRI.

Am I too old for endoscopic surgery?

Age alone is not the deciding factor. Overall health, bone quality and the pattern of narrowing on your MRI matter more.

If leg pain from spinal stenosis is limiting your walking, call 609-800-3472 or send your MRI for a review. You can also learn more about endoscopic spine surgery and spinal stenosis.

This article is for general education and is not medical advice.