Lumbar Spinal Stenosis Specialist · Naples & Fort Myers, FL
Lumbar Spinal Stenosis. The canal narrows. The nerves compress. Walking becomes impossible. It is treatable.
Lumbar spinal stenosis is one of the most common causes of leg pain and walking difficulty in adults over 50 — and one of the most undertreated. Dr. Katsevman specializes in decompressing the nerves with the least invasive approach possible: often no fusion, no hardware, same-day discharge, and a return to walking freely.
"Lumbar stenosis patients often think their walking limitation is just aging. It’s not — it’s a nerve being crushed in a narrowed canal. Relieving that pressure can give them back a decade of life."
Dr. G. Katsevman, MD · Neurosurgeon & Spine Surgeonwalking distance & freedom
through one tiny opening
minimally invasive surgery
alone is often enough
Understanding the condition
What is lumbar spinal stenosis?
Spinal stenosis is a narrowing of the spinal canal — the bony tunnel that houses the spinal cord and nerve roots as they travel from the brain to the body. When this canal narrows, the lumbar nerve roots inside are compressed. The result is back pain, leg pain, numbness, weakness, and the characteristic inability to walk more than a short distance before the legs give out.
Stenosis is typically a slow, progressive condition caused by the gradual degenerative changes of aging: discs bulge, facet joints enlarge with arthritis, ligaments thicken. These structures encroach on the canal from multiple directions simultaneously. Unlike a disc herniation, stenosis rarely resolves on its own — once the canal is structurally narrowed, only mechanical decompression can reliably restore the space the nerves need.
Recognizing your symptoms
What spinal stenosis feels like
Lumbar stenosis has a characteristic pattern — dominated by leg symptoms and walking limitation rather than back pain alone. Here is what to look for.
Neurogenic Claudication
The hallmark of lumbar stenosis. Leg pain, heaviness, cramping, or weakness that comes on with walking or standing and is relieved by sitting or bending forward. The "shopping cart sign" — leaning over the cart opens the canal and relieves pressure. Patients often describe being able to walk only a block before they must stop.
Pain Better When Sitting or Bending Forward
Flexing the spine slightly opens the posterior elements of the spinal canal, temporarily increasing the space available for the nerves. This is why sitting, bending forward, and leaning over a cart relieves stenosis pain — while walking upright or extending the spine worsens it. This pattern strongly distinguishes stenosis from vascular claudication.
Leg Pain, Numbness & Tingling
Bilateral (both legs) or unilateral radiating pain, numbness, or pins-and-needles in the buttocks, thighs, calves, or feet. Unlike disc herniation which typically causes one-sided electric pain, stenosis often causes more diffuse, bilateral heaviness and aching — though one side may be worse than the other.
Weakness & Leg Fatigue
Progressive leg weakness that worsens the longer a patient walks or stands. Patients describe legs that "just don’t work" after a short distance. In severe cases, foot drop (inability to lift the foot) can develop as the nerve root responsible for ankle dorsiflexion is chronically compressed.
Positive “Shopping Cart Sign”
Leaning forward over a shopping cart while walking dramatically relieves leg symptoms because spinal flexion opens the posterior canal. If you feel better hunched over a cart than walking upright, this is one of the most reliable clinical signs that your symptoms are from lumbar stenosis. The same mechanism explains why a stationary bike is easier than walking.
Progressively Worsening Walking Distance
The most telling functional marker: how far can you walk before you must stop? Patients with moderate stenosis can walk a few blocks. Severe stenosis may limit walking to less than 50 yards. Tracking this over months tells both patient and surgeon how fast the condition is progressing and how urgently intervention is needed.
⚠ Seek urgent care for these symptoms
Spinal stenosis is usually a slow, progressive condition. However, these symptoms require immediate evaluation:
- Loss of bowel or bladder control — cauda equina syndrome from acute severe lumbar stenosis is a surgical emergency
- Rapidly worsening weakness in both legs — progressive bilateral motor deficit needs urgent imaging
- Falls from leg weakness or foot drop — rapidly progressive motor loss needs urgent imaging
If you have any of these symptoms, go to the nearest emergency room or call 911.
What causes stenosis
Why the canal narrows
Stenosis is rarely caused by one thing — it is the cumulative result of multiple degenerative changes occurring simultaneously over years or decades.
Facet Joint Hypertrophy
The facet joints at the back of the spine enlarge with osteoarthritis, growing into the spinal canal and lateral recesses. Facet hypertrophy is one of the most common contributors to central and foraminal stenosis, particularly at L4-5.
Ligamentum Flavum Thickening
The ligamentum flavum — a yellow elastic ligament lining the back of the spinal canal — thickens and buckles inward with age, compressing the dural sac and nerve roots from the posterior. Often the primary compressive structure removed during laminectomy.
Disc Bulging or Herniation
Degenerative discs lose height and bulge posteriorly, contributing to anterior canal narrowing. A superimposed acute herniation in a pre-stenotic canal can cause rapid, severe compression even from a relatively small disc fragment.
Bone Spurs (Osteophytes)
Calcium deposits that form on vertebral endplates and facet joints as the body attempts to stabilize a degenerating motion segment. Osteophytes can grow directly into the spinal canal or the neural foramen, compressing nerve roots.
Spondylolisthesis
A vertebra that slips forward on the one below it narrows the spinal canal at that level. Degenerative spondylolisthesis is one of the most common causes of combined stenosis and instability in older patients — and the key determinant of whether fusion is needed alongside decompression.
Congenital Narrow Canal
Some patients are born with a naturally narrow spinal canal. They may be asymptomatic for decades, but when normal age-related changes begin to occur, even modest additional narrowing causes symptoms that would not trouble someone with a wider native canal.
Treatment options
From conservative care to surgery
Unlike disc herniation, spinal stenosis does not typically resolve on its own. But conservative care can manage symptoms and buy time. When it is no longer sufficient, surgery is the most reliable path to lasting improvement.
Conservative non-surgical care
Conservative treatment does not reverse spinal stenosis — the structural narrowing persists regardless of what non-surgical measures are taken. But it can meaningfully manage symptoms and improve function, particularly in milder cases or patients who are not yet ready for surgery.
Physical therapy — flexion-based exercise programs that train patients to keep the spine in a flexed position (which opens the canal) during walking and daily activities. Aquatic therapy is particularly effective for stenosis patients as water buoyancy reduces spinal loading.
Activity modification — using a cane or walker (which promotes a forward-flexed posture), riding a recumbent bike instead of walking, and avoiding prolonged upright standing.
Medications — NSAIDs for inflammatory component, neuropathic pain medications (gabapentin, duloxetine) for the nerve compression component, and short courses of oral steroids for acute exacerbations.
Epidural steroid injections
Epidural steroid injections for stenosis deliver anti-inflammatory medication to the compressed nerve roots, reducing swelling and temporarily increasing the effective space available to the nerves. They can provide weeks to months of meaningful improvement in walking distance and leg symptoms.
For lumbar stenosis, interlaminar or transforaminal lumbar epidural injections are most commonly used, targeting the compressed nerve roots directly at the stenotic levels. They can provide weeks to months of meaningful improvement in walking distance and leg symptoms.
Injections are a bridge — they treat the inflammation but not the underlying stenosis. Most patients with significant stenosis eventually outgrow their benefit.
Surgery — the right approach for your anatomy
Surgery is the most reliable and durable treatment for symptomatic spinal stenosis that has not responded to conservative care. The goal is to remove the structures compressing the nerves and restore the space they need. The approach Dr. Katsevman uses depends on the location of the stenosis, the number of levels involved, whether spondylolisthesis is present, and the degree of instability:
Surgical options — chosen for your anatomy
Learn more
From Dr. Katsevman’s blog
Patient guides on lumbar stenosis, neurogenic claudication, and your surgical options — written in plain language.
Common questions
What patients ask most
Will my spinal stenosis get worse without treatment? +
Unlike a disc herniation, which can resorb on its own, spinal stenosis is a structural problem — the bony canal and surrounding tissues have physically narrowed, and they do not spontaneously expand. Without treatment, most patients with moderate to severe stenosis experience gradual worsening over months to years: shorter walking distances, more frequent leg symptoms, and increasing disability. The pace varies — some patients plateau for a time, others decline steadily. Conservative care can manage symptoms but does not reverse the stenosis. Surgery is the only treatment that reliably and durably restores the space the nerves need.
Do I need fusion for spinal stenosis? +
Not always — and this is one of the most important questions to get right. Many patients with lumbar stenosis can be treated with decompression alone (laminectomy) without any fusion, particularly when the spine is stable and no significant spondylolisthesis is present. Dr. Katsevman’s minimally invasive tubular laminectomy preserves the posterior spinous process and ligaments, maintaining natural spinal stability and making fusion unnecessary in many cases where open surgery would have required it. When Grade I spondylolisthesis is present, the TOPS procedure offers a motion-preserving alternative to fusion. Fusion is recommended when genuine instability exists — not as a routine accompaniment to decompression.
What is the shopping cart sign and why does it matter? +
The "shopping cart sign" refers to the observation that patients with lumbar spinal stenosis feel dramatically better when they lean forward over a shopping cart while walking. Leaning forward flexes the lumbar spine, which opens the posterior spinal canal and lateral recesses, temporarily increasing the space available to the compressed nerve roots — relieving the leg symptoms. This same mechanism explains why stationary bikes and aquatic therapy (which keep the spine flexed) are helpful, and why walking upright on flat ground is harder than cycling or walking uphill. The shopping cart sign is a clinical hallmark of lumbar stenosis with high diagnostic specificity.
How is lumbar stenosis different from a herniated disc? +
Both compress lumbar nerve roots, but differently. A herniated disc is a focal, acute event — the disc nucleus escapes through a tear and presses on a specific nerve. It can resorb on its own over weeks to months. Lumbar stenosis is a chronic, structural problem — the entire canal narrows from multiple directions (facet hypertrophy, ligament thickening, disc bulging, bone spurs) and does not resolve without mechanical treatment. Herniated disc tends to cause sharp, one-sided, electric sciatica. Stenosis tends to cause more bilateral, diffuse leg heaviness, cramping, and walking limitation. Importantly, both can coexist — many patients have a narrow canal that is then worsened by a superimposed disc herniation. The MRI and clinical presentation distinguish the primary driver. See our herniated disc page for more.
What is the TOPS procedure and is it an option for my stenosis? +
The TOPS System is an FDA Breakthrough Device for lumbar spinal stenosis combined with Grade I spondylolisthesis. Rather than fusing the vertebrae after decompression, TOPS implants a mobile mechanical device that stabilizes the segment while preserving motion in all planes. In the FDA randomized clinical trial, TOPS achieved 77% overall clinical success versus 24% for fusion at 2 years — a dramatic difference. Dr. Katsevman is listed on the official Premia Spine TOPS surgeon locator. TOPS is indicated for patients aged 35–80 with moderate-to-severe stenosis and Grade I spondylolisthesis at one level from L3 to L5. If you have been told you need fusion for stenosis with spondylolisthesis, a consultation to evaluate TOPS candidacy is strongly worthwhile.
Can I get a second opinion on my spinal stenosis treatment? +
Absolutely. Many patients with spinal stenosis are recommended fusion when a minimally invasive laminectomy — or the TOPS procedure — would address the condition with less morbidity and equally good or better outcomes. Dr. Katsevman offers in-person and telemedicine second-opinion consultations for patients across Florida and nationally. Bring your MRI and any prior surgical recommendations. A second opinion from a fellowship-trained minimally invasive specialist frequently reveals options that were not offered — particularly the tubular laminectomy approach and TOPS.
"A patient who can barely walk to their mailbox — and six weeks after surgery is playing golf or pickleball — that is why stenosis surgery is so rewarding. The improvement can be dramatic and immediate."
Gennadiy (Gene) A. Katsevman, MD
Neurosurgeon & Minimally Invasive Spine Surgeon
Only surgeon in Naples performing up to 3-level tubular laminectomy through a single quarter-inch incision
Listed on the official Premia Spine TOPS™ surgeon locator — one of few TOPS-trained surgeons in Florida
Fellowship-trained at Barrow Neurological Institute under Dr. Juan Uribe — world pioneer in minimally invasive lumbar spine surgery
Neurosurgery residency, West Virginia University — Level 1 Trauma Center
30+ peer-reviewed publications in spine surgery and neurosurgery
Naples Top Doctor in Neurosurgery — 2024, 2025, and 2026
5-star Google rating · Healthgrades Choice Provider · WebMD Preferred Provider
Offices in Naples & Fort Myers · Telemedicine second opinions available nationwide
Take the next step
Lumbar stenosis is structural.
The solution should be too.
Schedule a consultation with Dr. Katsevman in Naples or Fort Myers — or by telemedicine. Bring your MRI. Find out whether tubular laminectomy, TOPS, or fusion is right for your anatomy.
6101 Pine Ridge Road #101
Naples, FL 34119
Fort Myers, FL 33919
Available statewide & nationally