Lumbar Canal Stenosis

Lumbar canal stenosis means decreased space in the spinal canal of the lumbar spine.  The space for the nerve roots in the lumbar spine region is compromised leading to compression of these nerve roots and its symptomatology.

This stenosis can be either central, lateral or foraminal.  Lumbar canal stenosis can be present at one or more than one level.  Depending on its location and number of levels involved, it may have varied presentations.

Causes of Lumbar Canal Stenosis/Etiology

Most common cause of lumbar canal stenosis is wear and tear or aging aka degeneration.  This leads to dehydration of the intervertebral disc with subsequent changes leading to bulging, herniation, extrusion or sequestration of a disc fragment, degenerative changes in the facet joints with hypertrophy, osteophytes formation around the back of the vertebral body as well as the facet joints, thickening and crumpling as well as ossification of the ligament around the back of the spinal nerves in the spinal canal. 

Depending on the location of these changes, patients may have presentations of a central, lateral foraminal lumbar canal stenosis.

MRI showing Lumbar Canal Stenosis

MRI showing Lumbar Canal Stenosis

Presentation of lumbar canal stenosis can be aggravated or occasionally solely caused due to traumatic injury of the lumbar spine leading to fracture, subluxation, dislocation, and injury to the facet of the intervertebral disk.  Also patients with congenital lumbar canal stenosis are at increased risk of presentation or symptoms of lumbar canal stenosis.

Symptoms or Presentations of Lumbar Canal Stenosis

Most common symptom of lumbar canal stenosis is radicular pain in either of the two lower extremities.  This pain may be associated with tingling, numbness and rarely weakness of the extremity.  Rarely, patients may have involvement of bowel, bladder as well as gait.

Patients with central stenosis usually present with symptoms of neurologic claudication in the form of pain, heaviness of both lower extremities with or without tingling, numbness in both lower extremities.

The presentation is aggravated with prolonged standing or walking certain amount of distance (called Claudication distance), which is usually fixed and may be decreasing with worsening condition.  These patients tend to improve with bending forwards and can be seen leaning over a grocery cart in a departmental store (Grocery cart sign) or making frequent stops and stooping forwards to relieve their pain.

Also these patients can go for longer distances on a bicycle and paradoxically going uphill is easier for them than going downhill on a slope.  Forward bending helps in decreasing the symptoms while bending backwards can worsen their symptoms.

Rarely these patients can present with acute symptomatology or worsening of neurological status, weakness with or without bowel or bladder involvement.  This presentation is termed as cauda equina syndrome that may need immediate and urgent intervention.

Natural History of Lumbar Canal Stenosis

Most patients with radicular symptoms improve over a span of 4 to 6 weeks and may have complete resolution of their symptoms with conservative treatment.  Patients with central canal stenosis especially that of multiple levels and presenting with neurologic claudication usually have mixed prognosis.  Studies have shown that a third of these patients will improve over time, a third will stay stable on same presentation while the third will worsen over time.  The presentations may be interspersed with episodic worsening and improvement, which can last 4 to 6 weeks.  Conservative means with occasional minimally invasive treatments may be required for management of symptoms in most of these patients.

Warning Signs or Red flags in Lumbar Canal Stenosis

The patients who have back pain with any of these following conditions should seek medical attention as soon as possible.

  1. Cancer, neoplasia or malignancy.
  2. Unexplained weight loss of more than 10 pounds in the last 6 months.
  3. Immunocompromised comorbidities like on chemo or radiotherapy or having disease like HIV or AIDS or being on prolonged corticosteroid therapy.
  4. IV drug users.
  5. Urinary tract infection.
  6. Fever of more than 100 degrees centigrade.
  7. Significant trauma from a fall or accident.
  8. Bowel or bladder involvement in the form of incontinence or retention.
  9. Weakness in the major joint of the leg.

Management of Lumbar Canal Stenosis

Most of the patients with lumbar canal stenosis presenting with radicular symptoms or claudication can be treated conservatively.  All patients except those who present with red flags should be tried with conservative treatment, which includes medications, physical therapy, change in lifestyle, control of predisposing factors.

If the patients are not improved with these measures then cortisone injection to the back may help in vast majority of these patients.  In patients who fail conservative treatment, surgical options should be explored to improve their symptoms and give them a better quality of life.

Surgical treatment essentially involves decompression of the nerve roots and allowing more space to help the nerve roots heal and patient to improve in its symptomatology.  This decompression can be done in various ways and from various directions namely front, side and back.  Decompression from the back is the most common way especially in patients who do not have the need for concomitant fusion.

Decompression from the back can be performed in a customary open or minimal invasive fashion depending on the patient’s characteristic and presentation.  Patients who need fusion surgery along with decompression can be treated from the back, from the side or from the front.  A decision as to what procedure and what approach needs to be undertaken is decided based on patient’s characteristic, presentation and decided in discussion with the patient prior to the surgery.

Surgical Procedures for Lumbar Canal Stenosis

Surgical procedures for lumbar canal stenosis include decompression laminectomy in which the back or the lamina of the vertebral body is removed along with removal of the ligament on the back of the levels to give more space.

This is associated with foraminotomy that is to clean up off the foramens through which the nerve roots pass and freeing the nerve root from the adhesions along its sides while the nerve root passes through the foramen.

Other notable procedures include laminotomy, foraminotomy among others.  Occasionally, patient may be a good candidate for lumbar laminoplasty in which the lamina is pried open and held in its place with the mechanical block so as to give more space for the nerve roots in the spinal canal.  Patients who need fusion surgery may need surgeries like anterior lumbar interbody fusion, lateral lumbar interbody fusion, posterior lumbar fusion, posterior lumbar interbody fusion, transforaminal interbody fusion.  These fusion surgeries can lead to indirect or direct decompression of the nerve roots.

Transforaminal atraumatic lumbar interbody fusion cage

The image shows a lumbar fusion done with transforaminal technique. The fusion is aided by the bone cage which is filled with bone graft. The fusion of the segment results relief from symptoms of lumbar canal stenosis.

Success Rate for Lumbar Canal Stenosis Surgery

Surgeries for lumbar canal stenosis are usually associated with high success rate.  The results are usually gratifying with alleviation of the symptoms of radiculopathy or neurologic claudication.  Patients with associated back pain who usually undergo a fusion surgery also have good results.

Risks and Complications of Surgery for Lumbar Canal Stenosis

As for all surgeries there are certain but rare risks for anesthesia including cardiac arrest, stroke, paralysis, and rarely death.

Risks of Lumbar spine surgery may include though not limited to:

  • Hematoma or hemorrhage
  • Damage to the major vessels which may result in a excessive bleeding, even death
  • Blindness
  • Damage to the dura, resulting in a cerebrospinal fluid leak
  • Failure, loosening or pull out of the graft, cage, implant or plate
  • Wound infection
  • Failure of fusion to happen
  • Damage to the nerve root(s) resulting in new onset or deterioration of preexisting pain, weakness, paralysis, loss of sensation, loss of bowel or bladder function, impaired sexual function, etc., which may or may not recover.
  • A few of these conditions may warrant repeat surgery

Certain patient population is at a higher risk for complication which include but are not limited to:

  • Smoking
  • Seizures
  • Obstructive sleep apnea
  • Obesity
  • High blood pressure
  • Diabetes
  • Other medical conditions involving your heart, lungs or kidneys
  • Medications, such as aspirin, that can increase bleeding
  • History of heavy alcohol use
  • Drug allergies
  • History of adverse reactions to anesthesia

Who are good candidates for Lumbar Canal Stenosis Surgery?

Patients who have radicular symptoms, especially pain or patients who have neurologic claudication and have failed nonsurgical or conservative treatment over a period of more than 6 weeks are usually good candidate for surgical management of lumbar canal stenosis.  Patients who also have concomitant back pain should fail a conservative treatment for more than 3 months before going for surgical management of lumbar canal stenosis and back pain.

Exercises that help in Lumbar Canal Stenosis

Exercises involving strengthening of the core muscles of the back that is the front and the back muscles of the back help in stabilization of the lumbar spine.  These should usually be performed under the supervision of a physician or a physical therapist.


Lumbar canal stenosis is a common phenomena in aging population.  Patients are asymptomatic in vast majority of population and do not need any treatment.  Patients who are symptomatic can usually be treated with conservative means with a successful outcome.  Patients who have failed conservative measures and patients with sudden or rapid onset or deterioration of neurological symptoms can be treated with surgery with good results.  Patients who have profound neurological involvement may have guarded recovery even after surgical management.

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Dr. Nakul Karkare is awesome! And patriotic! Thank you, Dr. Karkare for displaying the American Flag in your waiting room, honoring and mourning our military personnel, this Memorial Day, who died while serving in the United States Armed Forces.
00:52 30 May 23
Excellent and skilled orthopedic practice specializing in joint replacements. Dr Karkare was trained at the Hospital for Special Surgery and has excellent results, as do his associates!! Would gladly refer family members to the practice!!
00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
Victoria DeMatteo
19:49 10 May 23
I'm very happy St. Catherine's sent me to this office for treatment after I broke my collar bone! Unfortunately the break was too severe to repair on its own and I had to have it rebuilt a week after the injury. Dr. Vaksha did a great job fixing it. I'm three months out, and I have full use of the arm and shoulder. The whole office staff is very professional, accommodating, and welcoming. I hope to not need orthopedic services again, but Dr. Vaksha will be my number one choice if I or anyone in family suffers such am injury.
Tina Rivera
20:42 08 May 23
No one likes going to the doctor. But these people make it painless. I go for knees, hips and shoulders. At almost 70 Complete Orthopedics keeps my active life style running smoothly. Whether chasing my Grandson and even surfing again, I highly recommend them!!
Thomas Slavin
15:02 02 Mar 23
Dr. Kuo knowledgeable and competent surgeon- very good experience and more importantly great result.
Joseph McCoy
21:23 25 Feb 23
Dr Vaksha was so kind and helpful. He took extra time with us and explained things so thoroughly. Highly recommend. Office very clean.
Susan Bosinius
20:20 19 Feb 23
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

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