Every week, Keven Burns, MD, sees patients who tell him some version of the same story. They thought it was just aging.
The spine surgeon at the Scottsdale-based Spine Institute of Arizona hears the story from retirees who can no longer walk through a grocery store without stopping to rest. From golfers who quietly gave up the back nine years ago. From older adults who have gradually structured their lives around how far they can walk before their legs begin to ache, weaken or go numb.
Many never considered they might have a treatable spinal condition. “A lot of people in this boomer population are just accepting it as a form of aging,” Dr. Burns said. As the U.S. population ages, that misunderstanding is becoming increasingly consequential.
According to research published by JAMA , spinal stenosis affects an estimated 103 million people worldwide and remains the most common reason for spine surgery in the United States. Yet Dr. Burns believes many patients are reaching specialists later than they should, often after years of worsening symptoms and declining mobility.
“We’re seeing a lot of multi-level spinal stenosis in the later phase,” he said. For many patients, the issue is not simply pain. It is the gradual loss of independence.
When aging isn’t the problem
Lumbar spinal stenosis occurs when narrowing within the spinal canal compresses the nerves traveling through the lower back. One of the hallmark symptoms is neurogenic claudication — pain, heaviness, numbness or weakness in the legs that worsens with standing and walking and improves with sitting. The problem, Dr. Burns said, is that many patients do not recognize those symptoms as signs of a spinal disorder. Instead, they assume they are getting older.
Patients begin parking closer to stores. Taking frequent breaks while walking. Avoiding activities they once enjoyed. Over time, those adjustments become their new normal. “The symptoms of neurogenic claudication shouldn’t be accepted as part of the aging process,” Dr. Burns said. The consequences can extend well beyond the spine.
As walking tolerance decreases, patients often become less active. Muscle mass declines. Cardiovascular fitness deteriorates. Daily activities become more difficult. For some, the condition slowly reshapes their entire lifestyle.
The cost of waiting
Delayed diagnosis carries financial consequences as well. According to Dr. Burns, many patients spend years cycling through treatments that may temporarily manage symptoms without addressing the underlying cause of the problem. “The longer we wait, the more expense that is taken through the physical therapy routes, the injection routes, the ablation routes,” he said.
Dr. Burns describes lumbar spinal stenosis as fundamentally a “real estate problem.” The nerves simply do not have enough room.
While physical therapy and other conservative treatments can play an important role in many spine conditions, he noted that evidence supporting their ability to alter the long-term course of neurogenic claudication remains limited.
Meanwhile, patients often continue to lose mobility. “If we can treat a patient with neurogenic claudication, that’s one of our happiest patients,” Dr. Burns said. “They go from the point where they can’t stand and walk to the point where they can walk again.”
A referral problem hiding in plain sight
Dr. Burns believes patients are only part of the story. He also sees a growing need to educate primary care physicians, advanced practice providers and pain management specialists about the warning signs of spinal stenosis and when patients should be referred for surgical evaluation.
As healthcare becomes increasingly specialized, he worries that some patients remain in treatment pathways that delay definitive care. Many continue receiving injections while symptoms progress. Others are referred only after significant neurological decline has already occurred.
“We need to educate our primary care physicians to be on the lookout,” he said. That challenge extends beyond lumbar stenosis.
In the cervical spine, Dr. Burns said patients often dismiss declining balance, hand dexterity issues and coordination problems as normal signs of aging when they may actually reflect cervical myelopathy, a potentially progressive spinal cord disorder. By the time some patients arrive in a spine clinic, their disease has already advanced considerably.Insurance requirements can create additional delays. Even when imaging and clinical findings strongly suggest spinal stenosis, prior authorization requirements may force patients through additional treatment steps before surgery is approved.
Dr. Burns said those delays can be frustrating for both physicians and patients. In some cases, insurers rely heavily on radiology report language rather than surgeon interpretation of imaging studies. Small differences in wording can trigger denials, leading to peer-to-peer reviews, administrative appeals and additional waiting.
The result is often the same. More time passes while symptoms continue.
Why more stenosis procedures are moving outpatient
At the same time, treatment itself continues to evolve. Advances in minimally invasive techniques, anesthesia protocols and outpatient care pathways have allowed many spinal stenosis procedures to move from hospitals into ASCs. Lumbar decompressions, microdiscectomies and many one- and two-level cervical procedures can now be performed safely in outpatient settings for appropriately selected patients, Dr. Burns said.
More complex cases involving deformity, tumors, extensive multilevel disease or significant medical comorbidities will continue to require hospital-based care. But for many patients, outpatient surgery is becoming increasingly common.
The challenge ahead
Dr. Burns expects spinal stenosis to become an even larger healthcare issue over the next decade as the baby boomer generation continues to age.
The condition itself is not new. What concerns him is how often it remains unrecognized. Too many patients, he believes, are accepting progressive mobility loss as an inevitable part of growing older. In many cases, it is not.
“There are effective treatments for this condition, and many can be performed in an outpatient setting,” Dr. Burns said. The challenge is ensuring patients reach the right specialist before years of lost mobility become their new normal.
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