Out-of-state? Free MRI review + telehealth consult before you travel4.9 ★ · 619 Google reviewsBoard-certified — American Board of Orthopaedic SurgeryMinimally invasive, same-day spine surgery in Beverly HillsCall (424) 217-7463
Out-of-state? Free MRI review + telehealth consult before you travel4.9 ★ · 619 Google reviewsBoard-certified — American Board of Orthopaedic SurgeryMinimally invasive, same-day spine surgery in Beverly HillsCall (424) 217-7463
Spinal stenosis is a narrowing of the central canal that houses the spinal cord and nerves. As the space tightens, the nerves have less room and begin to complain — usually not with back pain, but with symptoms that travel into the legs. It develops slowly, most often in the lower back, and is one of the most common reasons older adults have trouble walking distances.
The narrowing typically comes from the gradual changes of aging: discs lose height, ligaments thicken, and bone spurs form, all of which crowd the canal. The hallmark is neurogenic claudication — leg pain, heaviness, or cramping that builds while standing or walking and reliably improves when you bend forward, sit, or lean on a cart.
Spinal stenosis is a degenerative spinal condition where pressure is put on the spinal cord and/or nerve roots after the spinal canal narrows. Pain, including issues from spinal stenosis, will affect 4 out of 5 Americans in their lifetime. Those experiencing back pain once have a four times higher risk of recurrence.
There are two types of spinal stenosis. The first type is called congenital or developmental stenosis, where the spinal canal is too small for nerve roots or the spine. The second, a more common type, develops from degeneration of the intervertebral disc, facet joints, and the inferior and superior vertebral bodies.
Spinal stenosis commonly occurs in the lower back (lumbar) and neck (cervical) regions and is more often found in people in their seventies.
Types of Spinal Stenosis Affecting Beverly Hills Patients
Spinal stenosis can present itself in different ways that affect people differently. Dr. Melamed will determine which type you have based on symptoms and location. Some common types associated with location include:
Lumbar Stenosis
Spinal stenosis in the lower back can cause pain/cramping in one or both legs after standing too long. These symptoms can become debilitating as they progress.
Cervical Stenosis
People with cervical stenosis may not experience symptoms until their spinal nerves or spine become squeezed from canal narrowing. Symptoms tend to progress gradually over time and may include:
Symptoms associated with cervical myelopathy need to be urgently evaluated. These symptoms include:
Decreased coordination/weakness of hands
Arm/hand tingling or numbness
Loss of balance
Gait change
Change in bowel/bladder habits
Thoracic Spinal Stenosis
It’s also possible to experience spinal stenosis in the thoracic region (middle) of your back; however, this is rare.
Spinal stenosis can also be categorized by the type of inflammation. Two common types include:
Foraminal Stenosis
Foraminal stenosis (lateral stenosis) involves inflammation/compression of the spinal nerve, causing it to become pinched, painful, or dysfunctional. Foraminal stenosis can occur at any region along the spine, but it’s most common in the lumbar region.
Central Canal Stenosis
Central canal stenosis involves inflammation/compression of the spinal cord. When there’s less space for the spinal cord, pain, pressure, or dysfunction happens anywhere below the area of compression.
On average, between 5 and 60 percent of spinal stenosis cases involve two different areas of the spine.
Recognizing Progressive Symptoms That Require Medical Attention
✓Leg pain, heaviness, or cramping that comes on with walking or standing
✓Relief when sitting, bending forward, or leaning on a cart
✓Numbness or tingling in one or both legs
✓Weakness or a feeling of unsteadiness in the legs
✓Ability to walk farther when leaning on a shopping cart
✓Back discomfort that is often milder than the leg symptoms
Some people may not experience any pain, weakness, or numbing at first, but these symptoms may become more pronounced with aging. When pain begins to affect daily life, treatment for spinal stenosis may become necessary.
When spinal stenosis begins to affect daily activities like walking, standing, or balance, it may be time to seek urgent medical attention. Even difficulty walking short distances can signal a potentially serious issue. Other signs to look out for include trouble lifting your foot (foot drop), loss of coordination, or changes in bladder/bowel function. These symptoms may indicate a risk for permanent nerve damage if not treated immediately.
What Narrows the Spinal Canal
Age-related thickening of the ligaments inside the canal
Bone spurs from arthritis narrowing the space
Loss of disc height that reduces canal room
Bulging or herniated discs pressing into the canal
Spondylolisthesis, where a vertebra slips forward
A canal that was naturally narrow from birth
Other causes include:
Tumors
Spinal injuries
Diagnostic Process: Confirming Spinal Stenosis and Determining Severity
Dr. Melamed listens for the telltale pattern — leg symptoms that worsen with walking and ease when leaning forward — and examines your gait, reflexes, and strength. An MRI shows exactly where and how tightly the canal is narrowed and which nerves are affected, and it distinguishes stenosis from vascular causes of leg pain. Pinpointing the specific level is what allows a focused decompression rather than a wide operation.
Getting an accurate diagnosis is essential when treating spinal stenosis. There are several diagnostic steps Dr. Melamed may take to properly diagnose your condition.
Clinical Evaluation and Medical History
Dr. Melamed may initially require a full physical examination, alongside disclosure of your medical history. He will evaluate the range of motion and flexibility and will look for signs of nerve compression.
X-Rays
An imaging test called an X-ray takes pictures of your back that may reveal spinal narrowing or other bone changes. Each photo taken uses a small amount of radiation.
Magnetic Resonance Imaging
Magnetic resonance imaging (MRI) is an imaging technique that takes photos of hard and soft tissue by using a magnet or radio waves. MRIs can also detect tumor locations, as well as disc or ligament damage.
Computed Tomography
Computed tomography (CT) imaging uses X-ray images from different angles and is ideal for people who are unable to have an MRI. Injected dye can reveal herniated discs, bone spurs, and tumors by outlining the spinal cord and nerves.
Treatment Options for Spinal Stenosis in Beverly Hills
Because the symptoms come and go with position, many people manage spinal stenosis for years without surgery. The plan starts conservatively — physical therapy that emphasizes flexion-based stretching and core strength, activity pacing, anti-inflammatory measures, and image-guided epidural injections that can relieve pressure symptoms for a meaningful stretch of time. Dr. Melamed gives this phase a genuine trial.
When walking distance keeps shrinking, or numbness and weakness advance, a decompression restores room for the nerves. Rather than the traditional open laminectomy that strips the supporting muscles, Dr. Melamed usually performs a muscle-sparing biportal endoscopic decompression (BESS): through incisions under a centimeter, he removes the thickened ligament and bone spurs crowding the canal while leaving the stabilizing muscles and structures intact. Most patients go home the same day, and because the decompression is targeted, a fusion can often be avoided entirely.
Treatment for spinal stenosis usually begins with conservative, non-surgical treatment before moving on to more advanced forms of surgical intervention.
Conservative Nonsurgical Options
For mild to moderate spinal stenosis, the following options may be suitable:
Pain medications or muscle relaxants to reduce pain/inflammation
Rest/restriction on activities that cause/worsen back pain
Cold/hot packs to reduce pain caused by muscle spasms or strains
Doctor-recommended physical therapy to stretch and strengthen muscles
Acupuncture for chronic low back pain
Regenerative therapies such as platelet-rich plasma (PRP) therapy and autologous stem cell therapy can also be effective in reducing inflammation and stimulating spinal tissue growth. PRP therapy uses a concentrated form of your own blood’s growth factors, while autologous stem cell therapy uses stem cells harvested from your bone marrow or adipose tissue.
Minimally Invasive and Surgical Procedures
If pain persists for a prolonged period of time after trying conservative treatments, then Dr. Melamed may suggest surgery. The goal of surgery is to relieve pain by reducing pressure on compressed nerves through spinal decompression procedures. These may include removing affected discs and stabilizing the spine with an anterior cervical discectomy and fusion.
Your recovery time depends on the type of procedure performed. If you’ve undergone a minimally invasive procedure to reduce spinal compression, you may fully recover within 4 to 6 weeks. However, if your procedure was more involved and included spinal fusion, it may take 4 to 6 months for you to make a full recovery.
Everyone recovers at their own pace, so it’s important to rest and take it slow at the beginning of recovery. At first, you should avoid bending or twisting, gradually allowing your body to do more each day. Following your specialist’s physical therapy routine is key to a quick recovery.
A week or two after surgery, many people feel comfortable enough to drive again. Most people can resume non-strenuous activities a month after surgery if they didn’t have spinal fusion surgery.
Why does leaning forward relieve my spinal stenosis pain?
Bending forward opens up the spinal canal and gives the crowded nerves a little more room, which is why sitting, leaning on a cart, or stooping quickly eases the leg symptoms. Standing upright and walking narrow the canal again, which is why the pain returns. This position-dependent pattern is one of the clearest signs of stenosis.
Does spinal stenosis always require surgery?
No. Many people control stenosis for years with physical therapy, activity pacing, and occasional injections. Dr. Melamed reserves surgery for when walking distance keeps shrinking or nerve symptoms advance despite those measures, and even then the goal is a targeted decompression, not a large operation.
Can spinal stenosis be treated without a fusion?
In most cases, yes. Stenosis is a space problem, not necessarily an instability problem, so simply creating room for the nerves is often enough. A muscle-sparing endoscopic decompression removes the thickened ligament and bone spurs while preserving the structures that keep the spine stable, which frequently makes a fusion unnecessary.
