Spinal stenosis is one of the most common reasons adults over 60 seek care for back and leg pain — and one of the diagnoses where patients most often feel like they’ve been handed a binary choice: live with it, or have surgery.
That framing is wrong. There’s meaningful middle ground, and for carefully selected patients, VAX-D spinal decompression is part of it.
Here’s what spinal stenosis actually is, why the “just get surgery” advice is often premature, and when decompression is worth trying.
What Is Spinal Stenosis?
Spinal stenosis means narrowing of the spinal canal — the bony channel that houses the spinal cord and nerve roots. When that canal narrows, the neural structures inside get compressed, leading to pain, numbness, tingling, and weakness that typically radiate into the buttocks and legs.
There are two main types:
Central stenosis involves narrowing of the central canal itself, compressing the cauda equina — the bundle of nerve roots that descends from the end of the spinal cord. The hallmark symptom is neurogenic claudication: leg pain or weakness that worsens with walking or standing and relieves with sitting or bending forward (the position that opens up the canal).
Lateral stenosis (or foraminal stenosis) involves narrowing of the small openings (foramina) where individual nerve roots exit the spine. This produces more focal, dermatomal symptoms — pain down the back of the leg (L5-S1), into the front of the thigh (L3-L4), or along the outer leg (L4-L5).
Stenosis is caused by a combination of factors that tend to accumulate with age: disc degeneration and loss of height (which narrows the foramen), facet joint hypertrophy (arthritis-related thickening), and ligamentum flavum thickening (the ligament at the back of the canal can hypertrophy and buckle inward). All three can contribute simultaneously.
The Surgery Question
Surgery for spinal stenosis — typically a laminectomy (removing bone to widen the canal) or a combination of laminectomy with fusion — can be highly effective for severe cases. The SPORT trial and other landmark studies have shown that surgery outperforms non-surgical care for patients with severe stenosis and significant functional limitation.
But “surgery works for severe stenosis” doesn’t mean “surgery is the right first step for moderate stenosis in a 65-year-old.” Many patients are told they need surgery based on imaging findings alone, without adequate trial of conservative care. MRI findings of stenosis are notoriously common in asymptomatic older adults — a patient can have significant canal narrowing on imaging and no meaningful symptoms.
The appropriate question isn’t “does the imaging show stenosis?” It’s “is this patient’s functional limitation severe enough, and have they exhausted conservative options, to justify surgical risk?” For many patients, the answer to the second part of that question is no — at least not yet.
Can VAX-D Help Spinal Stenosis?
This is the nuanced part. VAX-D was developed primarily for disc herniation, and the strongest evidence base is for disc-mediated nerve compression — not bony stenosis. There are important distinctions:
Where VAX-D is likely to help in stenosis:
Many stenosis patients have a significant disc component contributing to their canal narrowing. The disc degeneration that accompanies stenosis causes disc bulging that further encroaches on the canal. If you remove that disc bulge through decompression-driven retraction, you may meaningfully open up the available space even without changing the bony or ligamentous contributions.
Additionally, the facet joint loading that accompanies disc height loss is relieved by distraction. When we separate the vertebral bodies during decompression, we temporarily offload the facet joints, which can reduce the inflammatory pain component in facetogenic stenosis patients.
Where VAX-D is less likely to help:
Pure bony stenosis — where the canal narrowing is primarily from osteophytes (bone spurs), thick facet joints, or severely thickened ligamentum flavum — doesn’t respond to decompression in the same way. Bone doesn’t retract the way disc material does. If the canal narrowing is predominantly structural/bony, the mechanism that makes decompression effective for disc herniations doesn’t apply cleanly.
Severe stenosis with significant neurological deficit — weakness, bowel or bladder dysfunction, significant gait instability — is a medical urgency that requires surgical evaluation, not conservative care trials.
The Patient Profile That Responds Best
Based on 27+ years of clinical experience, the stenosis patients who tend to do well with VAX-D have some combination of the following:
- Mixed stenosis — canal narrowing from both disc and bony/ligamentous contributions, where disc component is identifiable on MRI
- Moderate stenosis — symptomatic but not severe; they can walk a meaningful distance before claudication kicks in
- No significant neurological deficit — pain and limitation, but strength and reflexes are intact
- Predominant symptoms at rest or with position changes rather than severe, constant neurological compromise
- Foraminal stenosis specifically — lateral narrowing with single-root compression tends to respond better than central stenosis with multi-level compression
What the Protocol Looks Like for Stenosis Patients
We modify the decompression protocol for stenosis patients in several ways:
We typically use lower distraction forces initially and increase more gradually, because stenosis patients can have more complex symptom patterns that require careful monitoring. We pay close attention to positional response — some stenosis patients do better with slight flexion positioning during treatment, which opens the posterior elements where much of the narrowing occurs.
We also combine decompression with specific manual therapy directed at the facet joints and paraspinal musculature, since the muscular guarding that develops around a stenotic segment often contributes significantly to pain and limitation. Decompression alone without addressing the soft tissue component misses part of the picture.
Typical course: 15-20 sessions over 5-6 weeks, same as herniation patients. Response is often slower, with functional improvement becoming more apparent in the second and third weeks as the cumulative rehydration and decompression effects build.
An Honest Word About Expectations
VAX-D will not reverse bony stenosis. The bone that has overgrown into the canal will still be there after treatment. What decompression can do is reduce the disc and inflammatory contributions to your symptoms — which, for many patients, represents the majority of their functional limitation even if the bony narrowing gets credited on their MRI report.
Some patients with moderate stenosis do 20 sessions of VAX-D and return to walking 45 minutes without claudication. Others improve partially. Others don’t improve meaningfully. The right patient selection process — imaging review, functional assessment, honest discussion of goals — is how we try to put patients in the first category and save the third category from an ineffective treatment course.
If you’ve been told surgery is your only option, it’s worth an evaluation to see if you fall into the category where conservative care still has something to offer.
Get an Honest Assessment
Bring your MRI and your imaging report. We’ll review the actual source of your canal narrowing — disc vs. bone vs. ligament, central vs. foraminal — and give you a direct answer about whether decompression is worth trying for your specific stenosis pattern.
Call 631-659-2980 or schedule your evaluation online. West Hills Chiropractic Pain Center, 400 W Jericho Turnpike, Huntington, NY 11743.
— Dr. Tom Oddo, DC CSCS CEAS, West Hills Chiropractic Pain Center