Ask Dr. Clary: Can Spinal Stenosis Pain Be Treated Without Surgery?

Dr. Clary explains why a surgical referral can be helpful, even for patients who don’t want surgical treatment for spinal stenosis pain.

spinal stenosis pain

“When I have patients with a diagnosis of spinal stenosis, there’s one question I hear a lot,” says Dr. Andrew Clary, orthopedic anesthesiologist and pain medicine specialist. “People want to know if they can expect the pain to go away without surgery. It’s understandable. The idea of surgery can be scary. But the answer isn’t a ‘yes’ or ‘no’—it’s a conversation.”

Evaluating appropriate treatment for spinal stenosis pain

“At Summit, we always begin with conservative treatments for spinal stenosis pain when appropriate,” explains Dr. Clary. “There are several nonsurgical treatments for a diagnosis of pain related to spinal stenosis. These include medications, therapy, or injections. Unfortunately, not everyone responds the same way to pain treatments. If conservative therapies don’t relieve pain, then I have a conversation about other alternatives. When I refer my patients to a spine surgeon, it’s because I think they might benefit from treatment that I don’t offer.

A surgical referral is a conversation, not a decision

“Basically, I send people to a surgical colleague to have a conversation about their treatment options,” he clarifies. “I don’t want them to be scared about that. But if we’ve unsuccessfully tried conservative treatments, it’s important to explore possible treatment options with a surgeon. Summit offers an extensive team of spinal stenosis experts, and we know some spinal stenosis pain does very well with surgery. If a problem is fixable with surgery, understanding the options is critical. In some cases, a surgical fix can buy a patient 10, 20, 30 or more years without pain. Our team knows which diagnoses do well with surgery and which patients are good surgical candidates.”

Timing is critical for some surgical options

Timing is another concern that may prompt a surgical referral. Some surgical treatments for back pain are best done within a certain window of time to be effective. “My fear—and one reason I make a surgical referral for certain patients—is that I don’t want them to miss that window of opportunity to benefit from surgery,” Dr. Clary explains.

Summit supports informed patient decisions

“Sometimes, spinal stenosis patients have pain that is very fixable with surgery—but they are adamantly against it,” he admits. “If a patient is so afraid of surgery that he or she would rather remain in pain, we will respect that. We just want to make sure patients make fully informed decisions about the treatment that’s right for them.

“All of us want to have good outcomes,” Dr. Clary concludes. “At Summit, we want our patients to be happy. We want them to get the best diagnosis we can offer, to understand why they are experiencing pain, and to get better. There may be steps they don’t want to take, and that’s fine. It’s our job to help patients understand the options so they can select the medical approach that is best for them. Then, our team of spine specialists will do our best to mitigate pain.” 

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