“Ask the Doctor” Column: Surgery for Spinal Stenosis

This is a column in which leading clinicians answer your questions about neuropathy – usually one question per issue, and more when we are able. Please send your questions to “Ask the Doctor” c/o Neuropathy News, The Neuropathy Association, 60 East 42nd Street, Suite 942, New York, NY 10165.

Dear Doctor: Please discuss surgery for spinal stenosis. My doctor says the surgery is strictly preventive; this will be my third operation in two years. One was successful, one was not. I have neuropathy from my sciatica down to my foot: is there any connection or help? - Marlene

Dr. Peter Donofrio Answers: The term spinal stenosis refers to a spinal canal that is too narrow for the spinal cord or caudal equina (horse’s tail) to function properly. Spinal stenosis can exist in the cervical area (neck), the thoracic region (middle of the back), or in the lumbar area (lower back).

A patient’s symptoms depend on the location of the stenosis.  In the neck, patients often have neck pain, pain radiating to the arms, spasticity or stiffness in the legs, weakness in the arms and legs, and bowel, bladder, or sexual problems.  In the thoracic region, patients may have mid-back pain, stiff and weak legs, as well as abnormalities of the bowel, bladder and sexual organs.  Lumbar spinal stenosis causes lower back pain, leg weakness, and often numbness and tingling in the legs.  Bowel, bladder and sexual dysfunction may occur as well. Symptoms can be worse on one side of the body. Patients with lumbar stenosis may present with ‘spinal claudication’ -- a phenomenon where they have few symptoms at rest, but develop pain, numbness and leg weakness whenever they walk a few blocks. Rest helps, but the symptoms recur when walking resumes.

You mention having sciatica down to your foot.  You do not state if it affects both legs.  Patients with lumbar spinal stenosis can have sciatic symptoms based on involvement of specific roots such as L5 and S1. There may be a definite connection between the spinal stenosis and your sciatic symptoms.

I do not understand the term “preventive” as it applies to surgery for your spinal stenosis.  It appears that you may already have spinal stenosis.  Possibly the surgeon means preventive in the sense that surgery will limit or inhibit further progression of disease and more severe symptoms. If I was advised to have a third spinal stenosis operation in two years, I would make certain that the operation was truly needed and offered a significant chance of success. So far, only one of your two surgeries has been successful. The lumbar surgery for spinal stenosis tends to be multi-level and extensive and is a challenging operative for even the most skilled surgeon. If you have a diffuse and symmetric neuropathy in addition to the sciatic symptoms and spinal stenosis, the diffuse neuropathy will not improve post-operatively.  Some of your symptoms mimicking neuropathy may improve if the surgery is successful. You may wish to seek another opinion before proceeding to a third surgery.

Dr. Donofrio

Peter D. Donofrio, M.D. is Professor of Neurology and Director of the Neuromuscular Division of the Department of Neurology at Vanderbilt University Medical Center.


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