Adam C. Young, MD
Alan C. League, MD
Albert Knuth, MD
Alejandra Rodriguez-Paez, MD
Alexander E. Michalow, MD
Alexander Gordon, MD
Alexander M. Crespo, MD
Alfonso Bello, MD
Ami Kothari, MD
Amy Jo Ptaszek, MD
Anand Vora, MD
Andrea S. Kramer, MD
Andrew J. Riff, MD
Angela R. Crowley, MD
Angelo Savino, MD
Anthony Savino, MD
Anuj S. Puppala, MD
Ari Kaz, MD
Ashraf H. Darwish, MD
Ashraf Hasan, MD
Bradley Dworsky, MD
Brian Clay, MD
Brian J. Burgess, DPM
Brian R. McCall, MD
Brian Schwartz, MD
Brian Weatherford, MD
Brooke Vanderby, MD
Bruce Summerville, MD
Bryan Waxman, MD
Bryant S. Ho, MD
Carey E. Ellis, MD
Carla Gamez, DPM
Cary R. Templin, MD
Charles L. Lettvin, MD
Charles M. Lieder, DO
Chinyoung Park, MD
Christ Pavlatos, MD
Christian Skjong, MD
Christopher C. Mahr, MD
Christopher J. Bergin, MD
Craig Cummins, MD
Craig Phillips, MD
Craig S. Williams, MD
Craig Westin, MD
Daniel M. Dean, MD
David Beigler, MD
David Guelich, MD
David H. Garelick, MD
David Hamming, MD
David Hoffman, MD
David M. Anderson, MD
David Norbeck, MD
David Raab, MD
David Schneider, DO
Djuro Petkovic, MD
Douglas Diekevers, DPM
Douglas Solway, DPM
E. Quinn Regan, MD
Eddie Jones Jr., MD
Edward J. Logue, MD
Ellis K. Nam, MD
Eric Chehab, MD
Eric L. Lee, MD
Evan A. Dougherty, MD
Garo Emerzian, DPM
Gary Shapiro, MD
Giridhar Burra, MD
Gregory Brebach, MD
Gregory J. Fahrenbach, MD
Gregory Portland, MD
Harpreet S. Basran, MD
Holly L. Brockman, MD
Inbar Kirson, MD, FACOG, Diplomate ABOM
Jacob M. Babu, MD, MHA
Jalaal Shah, DO
James M. Hill, MD
James R. Bresch, MD
Jason G. Hurbanek, MD
Jason Ghodasra, MD
Jason J. Shrouder-Henry, MD
Jeffrey Ackerman, MD
Jeffrey Goldstein, MD
Jeffrey Staron, MD
Jeffrey Visotsky, MD
Jeremy Oryhon, MD
John H. Lyon, MD
Jonathan Erulkar, MD
Jordan L. Goldstein, MD
Josephine H. Mo, MD
Juan Santiago-Palma, MD
Justin Gent, MD
Justin M. LaReau, MD
Kellie Gates, MD
Kermit Muhammad, MD
Kevin Chen, MD
Kris Alden MD, PhD
Leah R. Urbanosky, MD
Leigh-Anne Tu, MD
Leon Benson, MD
Lori Siegel, MD
Lynn Gettleman Chehab, MD, MPH, Diplomate ABOM
Marc Angerame, MD
Marc Breslow, MD
Marc R. Fajardo, MD
Marie Kirincic, MD
Mark Gonzalez, MD
Mark Gross, MD
Mark Hamming, MD
Mark Mikhael, MD
Matthew L. Jimenez, MD
Mehul H. Garala, MD
Michael C. Durkin, MD
Michael Chiu, MD, FAAOS
Michael J. Corcoran, MD
Michael O'Rourke, MD
Nathan G. Wetters, MD
Nikhil K. Chokshi, MD
Paul L. Goodman, DPM, FACFAS, FAPWCA
Peter Hoepfner, MD
Peter Thadani, MD
Phillip Ludkowski, MD
Priyesh Patel, MD
Rajeev D. Puri, MD
Rhutav Parikh, MD
Richard J. Hayek, MD
Richard Noren, MD
Richard Sherman, MD
Ritesh Shah, MD
Robert J. Thorsness, MD
Roger Chams, MD
Ronak M. Patel, MD
Ryan J. Jacobs, MD
Scott Jacobsen, DPM
Sean A. Sutphen, DO
Serafin DeLeon, MD
Shivani Batra, DO
Stanford Tack, MD
Steven C. Chudik, MD
Steven G. Bardfield, MD
Steven Gross, MD
Steven J. Fineberg, MD
Steven Jasonowicz, DPM
Steven M. Mardjetko, MD
Steven S. Louis, MD
Steven W. Miller, DPM
Surbhi Panchal, MD
T. Andrew Ehmke, DO
Taizoon Baxamusa, MD
Teresa Sosenko, MD
Theodore Fisher, MD
Thomas Gleason, MD
Timothy J. Friedrich, DPM
Todd R. Rimington, MD
Todd Simmons, MD
Tom Antkowiak, MD, MS
Tomas Nemickas, MD
Van Stamos, MD
Wayne M. Goldstein, MD
Wesley E. Choy, MD
William P. Mosenthal, MD
William Vitello, MD

Spinal Stenosis: The Latest Treatment Options

Featuring Adam Young, MD, IBJI Board-Certified Anesthesiologist and Pain Management Physician

Adam C. Young, MD

Adam C. Young, MD

Anesthesiologist and Interventional Pain Management Physician

Dr. Young is a board-certified anesthesiologist and pain management physician, fellowship-trained in pain management.

Spinal stenosis, or narrowing within the spinal canal, is a common problem we face as we age, according to Adam Young, MD, an interventional pain management physician. “It can produce pain that requires treatment.”

Dr. Young helps patients enjoy lives that are more comfortable and convenient, improving quality by reducing pain symptoms. He understands the complex nature of pain and the psychological stress it can cause. 

Pain Management Expertise for Spinal Stenosis

Dr. Young treats patients of all ages who present with a variety of pain ailments. He sees patients at the IBJI Morton Grove office where he can perform many pain-relieving procedures. He offers a long list of treatment options, including steroid injections for joint pain, nerve blocks, radiofrequency ablation along the spine and joints, spinal stenosis treatments, compression fracture treatments, and spinal cord and DRG stimulation.

This blog discusses a common complaint among older patients — spinal stenosis — and the treatments that can be done to help alleviate this pain. 

Non-Invasive Care for Spinal Stenosis

Dr. Young always considers the safety of any intervention when treating pain, highlighting the lower risks of many of these treatments. “There are an increasing number of options that exist to treat spinal stenosis and most patients will be a candidate for one of them,” he says.

A Closer Look at the MILD Procedure to Treat Spinal Stenosis

The MILD procedure stands for minimally invasive lumbar decompression (Dr. Young discusses this at 18:48 of his pain management webinar.) “When we talk about side effects, the MILD procedure has a safety profile consistent with an epidural injection, which is exceptionally low,” he says.

A “bunched up” ligament can cause pain for patients.

The red triangle (in the photo) is the narrowed canal, Dr. Young explains. ”That’s a narrowed spinal canal. Normally it’s much larger and very round. That thick black piece of tissue is a specific ligament that stretches from the base of our head down to our tailbone. That ligament is a full length and stays that way our entire lives. As we age and decrease in height over time, the ligament starts to bunch up.” 

The MILD procedure can be an option if that ligament is part of the problem, he explains. “This is another tool in our toolbelt in managing spinal stenosis,” he says. “It’s a simple outpatient procedure that is very safe.”

MILD has become a popular option with a growing number of patients showing interest in it.

“It’s a nice option for patients who are interested in something more than epidural injections to treat their spinal stenosis. And they’re not prepared for surgery that requires hospitalization or an extended recovery period,” Dr. Young says.

“A lot of people don’t realize that they are weak or deconditioned, so I recommend physical therapy afterwards to regain strength and stamina. Patients who have good results two months following the MILD procedure usually have continued relief that can last up to five years.”

Steroid Injections for Spinal Stenosis

Dr. Young can reduce or eliminate inflammation and pain with steroid injections

“An epidural injection is the most common approach,” he says. “Injecting steroids in those areas of the spine can lead to some relief.”

If there is an anatomical problem such as a bulging disc present, or overgrown joints in the back, advanced procedures are required. 

“Injections are the first line option for these things and then when it comes to next steps, we start to discuss the MILD procedure,” Dr. Young says.

“All of my injections that I typically perform are under image-guidance. It helps me to be quite precise in where those injections are actually delivered.”

What Are Interspinous Spacers?

Interspinous spacers are a newer technology and offer an option for individuals who have spinal stenosis without evidence of ligamentum flavum thickening,” Dr. Young says. “They can be implanted under twilight anesthesia, utilizing a very small incision, and followed by a short recovery phase of two weeks. After that time, patients are encouraged to return to their regular activities.”

The difference between spacers and the MILD procedure is that you’re propping open the spine, like a jack, to keep the space open.

The spacers are made of titanium and the procedure itself is considered outpatient surgery. “My patients will need to avoid bending at the waist, twisting at the waist, and avoid lifting over 10 pounds for two weeks to allow the device to settle and scar into place,” Dr. Young says.

Who Does This Work for?

This procedure helps the type of patient who has to lean over to walk. “One thing I see as I watch older people is that they’re leaning forward, they may be using a walker or leaning over their shopping cart to lessen the pain of their spinal stenosis,” Dr. Young says.

With a small incision, a small device can be placed between the bones of the spine in a way that does not alter the physical anatomy of the spine. The device is custom fit for each individual patient and has metallic wings that allow it to wedge itself into position and prevent the collapse of the spine that leads to the pain associated with spinal stenosis.

“Based on the studies of this specific technique, patients who are feeling better at six months will still be doing well after two years,” Dr. Young says.

The procedure is done in a surgical center on an outpatient basis.

Conditions to Be Met Prior to Interspinous Spacer Surgery

“Patients will need to have a bone density scan prior to the procedure to make sure the bones are strong enough to withstand any extra force or torsion from that device,” Dr. Young says. “We also need to take special X-rays of your spine to show that there’s no shifting of the bones at that level. These are things that can be done right here in our office.”

When Can Patients Expect Relief?

Maximum relief is seen at six months,” Dr. Young says. “That isn’t to say that patients won’t experience relief earlier. Patients will have improvements in their back pain and their leg pain and that benefit has been maintained for about two years. Beyond two years, we still have improvements in both the back and legs. I know a lot of folks who have very realistic expectations because they’ve had pain for a long time. If you can reduce their pain by 70 percent, if you can make that big of a dent in their pain, it can make a huge improvement in their quality of life.” 

What Can Patients Expect During a Visit?

“When I first meet patients, I like to start from scratch,” Dr. Young says. “I meet with them in the office to discuss their symptoms: what hurts, when it hurts, and how it hurts. I like to know what they’ve tried, and I review any pertinent imaging. We can always get images in the office if they don’t have them. We review any tests they may have had in the past.”

What Happens After Diagnosis?

“I like to give patients a list of their options once I have a firm diagnosis of what’s going on,” Dr. Young says. “But they may come in with a pain complaint which is not so clear, so there may be additional tests. Once we have a working diagnosis, I like them to know they have options, from referral to a PT, prescription medications that work in a  variety of different ways, and I’ll often suggest a minimally invasive procedure, whether it’s an injection or something more advanced.”

How Do You Assess Pain Level?

“I think that one of the things I try to do is determine how much it’s interfering with their daily life,” Dr. Young says. “They’ll say, ‘I wish I could just get a good night’s sleep, but I’m always in pain.’”

“There are many different ways that patients can tell me what is being affected by their pain and then we can look at how successful we can be to reduce the symptoms so they can walk and experience less pain and less fatigue.”

Schedule an Appointment with an IBJI Pain Management Physician

Experiencing pain? Schedule an appointment with one of our IBJI Pain Management Physicians. Check with your insurance plan to see if you need a referral.

*Some of the content in this blog has been excerpted from Dr. Young’s Webinar