Spinal stenosis: is surgery the only option?

If you've been told "surgery is the only way," read this first

Key points in 30 seconds

1. Spinal stenosis is not a condition that always gets worse if left alone. In a study that followed patients for more than 10 years, the proportions who improved, stayed the same, and got worse were similar.
2. Studies comparing surgery with non-surgical treatment reach mixed conclusions. We're not at the stage where either can be called clearly better.
3. In a study that followed 378 people for 3 years after inpatient integrative treatment at Korean medicine hospitals, improvements in pain and walking time were maintained.
4. Whether treatment is working is measured more accurately by "how long you can walk without stopping" than by back pain.
5. If your legs become weak, you can't lift the front of your foot, or your bladder or bowel function changes, go straight to a hospital that can perform surgery.

What we often hear

• "After walking just a little, my legs go numb and I have to sit down before going on."
• "My legs are more numb than my back hurts."
• "It's a bit better when I push a shopping cart."
• "I was told I need surgery, and I'm scared."
• "I used to be able to walk all the way around the market. Now I can't make it halfway."

Many people come to us after writing off their gradually shrinking walking distance as just getting older.

Here's what happens on your first day

• Where it has narrowed and by how much. If spinal stenosis is suspected, we check with MRI in partnership with the radiology clinic on the 2nd floor of the same building. On the first day, we also sort out whether there are any signs that need emergency attention.
• How many minutes you can walk right now. We measure how long you can walk without pain. This time is the first standard we use to judge whether stenosis treatment is working.
• How much and how you should walk. We set how much you'll walk each day and when to rest before walking again. This isn't treatment that stops you from walking; it's treatment that keeps you walking.

If I have spinal stenosis, should I prepare for surgery?

"My MRI shows severe stenosis, and I was told surgery is the only option." This is what we hear most often from people who come in with stenosis. In fact, many have already been advised to have surgery somewhere else.

To answer this question, we need to look at three things in order: what happens without treatment, how much better surgery is, and how other treatments besides surgery perform.

Let us make one thing clear first. If your legs are getting weak or you can't control your bladder or bowels, this article isn't about you. In that case, a surgical evaluation comes first. We'll come back to this later.

Does it keep getting worse if left alone?

No. There's a study that followed stenosis patients for an average of 11 years. The results showed similar proportions of people who improved, stayed the same, and got worse. Despite the frightening impression the diagnosis gives, not everyone got worse over time.

This is because how narrow things look on imaging doesn't necessarily match the actual symptoms. Even if the narrowed passage stays the same, symptoms go up and down depending on posture, muscle strength, and activity level. Symptoms can change even when the structure stays the same — this is where non-surgical treatment has room to work.

Of course, some people definitely do get worse. Identifying in advance who will get worse is still a question research is working on.

Is surgery clearly better?

There's no conclusion yet. In an analysis pooling 5 trials with 643 patients comparing surgery and non-surgical treatment, no meaningful difference was found in difficulty with daily activities. However, this analysis itself was rated as having low-quality evidence.

There are reports pointing the other way too. A large US study found that the surgery group did better, and the neurosurgical community formally challenged the methods of the analysis above.

To be honest, neither the evidence that surgery is clearly better nor the evidence that non-surgical treatment is better is settled yet. The answer depends on the patient's condition.

So the point that actually matters isn't "Don't have surgery." It's that, unless it's an emergency, there should be a step of trying non-surgical treatment thoroughly before surgery.

What happened to people who received Korean medicine treatment?

There's a study that checked again, about 3 years later, on people who received inpatient integrative treatment at four Korean medicine hospitals specializing in the spine. It included 378 patients, average age 62, with stenosis confirmed by MRI, and the average hospital stay was 23 days. They received acupuncture, electroacupuncture, pharmacopuncture (herbal acupuncture), Chuna (Korean manual therapy), and herbal medicine together.

Here are the results after 3 years.

Item	At admission	After 3 years
Back pain (out of 10)	5.7	3.5
Leg pain (out of 10)	4.8	2.5
Daily life difficulty score	45.7	28.4
Walking time without pain	19 minutes	About 48 minutes

There are two things worth noting. First, 55.6% of these patients had been advised to have surgery before admission. That means it wasn't just people with mild cases. Second, the proportion who actually had surgery within 3 years was 10.1%.

What we want to be clear about

Spinal stenosis is a condition whose course varies greatly from person to person. Even research can't neatly separate how much of the improvement was due to treatment and how much was just the passage of time.

That's why we measure walking time. If it's increasing, we continue; if it isn't, we change direction or recommend a hospital that can do a surgical evaluation. This is so we don't put off the decision.

So here's the order we follow

First, we identify cases where surgery comes first. Weakness that keeps you from lifting your toes or the top of your foot, changes in bladder or bowel control, and abnormal sensation around the inner buttocks are emergency signs. At that point, it's not time to talk about treatment — we send you straight to a hospital that can perform surgery.

Second, if there are no emergency signs, time is on our side. Stenosis isn't a condition that only goes one way. Trying treatment, checking the response, and then deciding about surgery usually costs you nothing.

Third, we set the goal as "walking time." The real suffering of stenosis isn't so much back pain as having to stop while walking. Walking time can be measured, and you can check it yourself. If this number is going up, the treatment is working.

Fourth, we make walking part of treatment. It's easy to fall into a cycle: it hurts so you walk less, walking less makes you weaker, and that makes it hurt more. We protect your daily walking with how to use a back brace, posture, and resting before the numbness starts and then walking again.

Fifth, if there's no response, we don't delay a surgical consultation. Non-surgical treatment isn't just a way to avoid surgery; it's also a process for figuring out whether surgery is truly needed.

Here's what we do

We start with imaging. If stenosis is suspected, we check with MRI, in partnership with the radiology clinic on the 2nd floor of the same building, where it has narrowed, by how much, and whether there are other problems. At the first visit, we screen for emergency signs first. We don't make a stenosis treatment plan without imaging.

We use several treatments together. We manage pain and inflammation with acupuncture, electroacupuncture, and pharmacopuncture, loosen spinal alignment and stiff areas with Chuna, and add herbal medicine based on blood tests and body composition tests. We bring the experience of 14,286 Chuna sessions in total (as of September 2026) to this process.

We record walking time. At the first visit, we measure how long you can walk without pain, and compare it each time we see you. Walking time is the first standard we use to judge whether stenosis treatment is working.

We give you a walking plan as well. For each patient, we decide and tell you whether to use a back brace, how much to walk each day, and when to rest before walking again. We aim for treatment that keeps you walking, not treatment that stops you from walking.

If nothing changes, we recommend a surgical consultation. If walking time doesn't increase after a set period of treatment, or if nerve symptoms progress, we recommend seeing a hospital that can do a surgical evaluation.

The course differs from person to person depending on how narrow it is, age, muscle strength, and other conditions. There are definitely cases where surgery is the best option.

If you don't check now

Stenosis isn't a condition that gets worse suddenly. That's why it's easy to put off.

But something progresses quietly while you wait: your walking distance shrinks. It hurts so you walk less, walking less weakens your legs, and weaker legs mean you can walk even less. Once you're in this loop, your life narrows regardless of how severe the stenosis is.

And there are signs you must not miss: being unable to lift the front of your foot, changes in bladder or bowel control, or weakness in both legs. If you miss the right time in these cases, it becomes hard to reverse.

What changes

What we measure is how long you can walk without stopping.

Going from 5 minutes at first to 10 minutes, then 20. Walking all the way around the grocery store without sitting down partway. Going for a walk with your grandchildren and not being the first to ask for a rest.

If this number is going up, the treatment is working. If it isn't, we change direction or recommend a surgical consultation. Either way, we look at the numbers and decide together.

Who should come see us

• People whose legs go numb while walking, so they keep sitting down to rest
• People whose walking distance has shrunk compared with before
• People who've heard talk of surgery and can't decide
• People whose legs are more numb than their back hurts

We're not here to talk you out of surgery. We measure how many minutes you can walk now, and if that time doesn't increase with treatment, we'll be the first to recommend a hospital that can do a surgical evaluation.

Sources used in this article

Source	What was studied	Result
Minamide et al., 2013	Stenosis patients followed for an average of 11 years	Similar proportions improved, stayed the same, or worsened; doesn't only go one way
Zaina et al., 2016 (Cochrane)	5 trials of surgery vs. non-surgical treatment, 643 people	No meaningful difference in daily life difficulty; but evidence quality low
Weinstein et al., 2008	Large US study	Reported the surgery group did better (with issues of patients crossing over between groups)
Kim et al., 2021	378 inpatients at 4 Korean medicine hospitals, 3-year follow-up	Improvements in pain, function, and walking time maintained; 10.1% had surgery within 3 years

References

1. Minamide A, Yoshida M, Maio K. The natural clinical course of lumbar spinal stenosis: a longitudinal cohort study over a minimum of 10 years. Journal of Orthopaedic Science. 2013;18(5):693-698. doi:10.1007/s00776-013-0435-9. PMID: 23839003

2. Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database of Systematic Reviews. 2016;(1):CD010264. doi:10.1002/14651858.CD010264.pub2. PMID: 26824399

3. Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. New England Journal of Medicine. 2008;358(8):794-810. doi:10.1056/NEJMoa0707136

4. Kim D, Shin J-S, Moon Y-J, et al. Long-term follow-up of spinal stenosis inpatients treated with integrative Korean medicine treatment. Journal of Clinical Medicine. 2021;10(1):74. doi:10.3390/jcm10010074

5. Ammendolia C, Rampersaud YR, Southerst D, et al. Effect of a prototype lumbar spinal stenosis belt versus a lumbar support on walking capacity in lumbar spinal stenosis: a randomized controlled trial. The Spine Journal. 2019;19(3):386-394. doi:10.1016/j.spinee.2018.07.012

---

If you keep having to stop and rest while walking, come see us once. We'll start by measuring how long you can walk without stopping.

For questions or appointments, message us in English through the messenger at the bottom right of the page, or call +82-53-716-1175.