Advised to Have Surgery for Spinal Stenosis? Five Questions to Ask

If you've been told, "The narrowing is severe. You'll need surgery."

In the hospital corridor after hearing that, most people can't ask anything. Their mind goes blank.

Only after getting home do they start searching online: whether they really need surgery, whether there's another way, whether they can trust what this hospital said.

Let us be clear first: this article isn't meant to talk you out of surgery. There are definitely cases of spinal stenosis where surgery is the best option.

But we'd like you not to hand that decision over entirely to someone else. So we've written down five questions to ask at any hospital. You should ask us the very same questions if you come to us.

What we often hear

• "I came here after being told I need surgery."
• "I couldn't ask anything at the time."
• "I don't know whether I can trust what that hospital told me."

Question 1. "Do I have any urgent warning signs right now?"

• Weakness that keeps you from lifting your toes or the top of your foot
• Changes in bladder or bowel control
• Abnormal sensation on the inner buttocks

If you have even one of these three, you don't need to read the rest of this article. This isn't the time to weigh other options. You need a surgical evaluation first.

On the other hand, if you have none of the three, time is on your side. In stenosis without urgent signs, there aren't many reasons it has to be done "right now."

Question 2. "Do my images match my symptoms?"

How narrow it looks on imaging and how much it actually hurts don't always go together.

Even in the same person, symptoms go up and down depending on posture, muscle strength, how much you move and whether there's inflammation.

So you should ask: does the narrowed spot on the images match the leg that's going numb now? And is there any other cause that could explain these symptoms?

Deciding on surgery from images alone is different from deciding after matching the images with the symptoms.

Question 3. "How much non-surgical treatment have I tried, and how?"

Studies comparing people who had surgery with those who didn't reach mixed conclusions. It's not settled that one is better; the answer differs from person to person.

So the principle accepted around the world is this: if there are no urgent signs, decide after giving non-surgical treatment a proper try.

The word "proper" matters here.

Taking painkillers for a few weeks is different from setting a time frame and working on pain, misaligned posture and walking together.

If you haven't tried the second yet, that card is still in your hand.

Question 4. "What will surgery improve, and what will remain?"

What surgery fixes is the narrowed passage. It can work very well for numbness that comes on while walking.

But even if the passage is widened, it doesn't reverse the wear on the spine that comes with age. Sometimes surgery is needed again later.

So you should ask: what will this surgery improve and what will remain, and how likely is it that I'll need surgery again at my age and in my condition?

A good doctor welcomes this question.

Question 5. "Do I lose anything by putting off the decision?"

For stenosis without urgent signs, here's what research tells us.

In a study that followed people with stenosis for more than 11 years, similar proportions improved, stayed the same and got worse. It's not a condition that always gets worse if left alone.

There's also a study that followed 378 people with stenosis for about 3 years after they were admitted to a Korean medicine hospital and received acupuncture, pharmacopuncture, Chuna and herbal medicine together. More than half had already been advised to have surgery before being admitted, but only 1 in 10 actually went on to have surgery.

That means taking time to try non-surgical treatment doesn't take away your chance to have surgery.

If anything, that time helps show whether surgery is really needed.

The decision is yours

Once you've heard answers to these five questions, whichever way you choose is your decision.

Our role is to prepare the information you'll use to make it.

First, we match the images with your symptoms. In partnership with the radiology clinic on the 2nd floor of the same building, we check where it's narrowed and by how much, and at the first visit we sort out whether there are urgent signs. If there are, we don't treat you; we first refer you to a hospital that can evaluate you for surgery.

Next, we set a time frame and treat intensively. We work on pain and posture with acupuncture, pharmacopuncture, Chuna and herbal medicine made up based on your test results. And we make walking part of the treatment. This is the "properly tried treatment" we mentioned in Question 3.

And we judge by walking time. If the "time you can walk without stopping" that we measured on the first day is increasing, we continue. If it doesn't increase, or your leg strength drops further, we recommend a surgical consultation first.

Non-surgical treatment isn't a way of avoiding surgery. It's also a process of finding out whether surgery is really needed.

What we're aiming for

Days when, instead of searching "Do I need surgery?", you're counting "How many minutes did I walk this week?"

The course differs from person to person depending on how narrowed it is, your age and muscle strength. And there are definitely cases where surgery is the best option. But it's not too late to make that decision after you've heard the answers to these five questions.

If you've been searching online after being advised to have surgery, first write these five questions down on paper. Then ask them, wherever you go.

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

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We've summarized the original studies mentioned here in the director's column Spinal stenosis: is surgery the only option?.