Spinal stenosis is a narrowing of the spinal canal that makes walking and standing painful and eases when you sit or lean forward. At PHI in Beverly Hills, board-certified physicians Dr. Faisal Lalani and Dr. Nadiv Samimi manage it with targeted epidural injections and regenerative options, with honest guidance on when surgical referral makes sense.
When Walking Becomes Hard
Spinal stenosis has a distinctive pattern that most patients recognize quickly once they hear it described. Walking or standing causes pain, weakness, or numbness in your legs. Sitting down or leaning forward gives relief. The pain is rarely worse at rest; it builds when you are upright and active.
You may have noticed that you can walk a short distance and then need to stop and sit, that pushing a shopping cart is more comfortable than walking upright, that standing for long periods is increasingly difficult, that walking uphill is somehow easier than flat ground, and that the symptoms have developed gradually over years rather than suddenly. If this sounds like your experience, the pattern is recognizable, the diagnosis is straightforward when it fits, and we can help you understand your options.
What’s Actually Happening
The spinal canal is the space inside your spine through which the spinal cord and nerves travel. Spinal stenosis means this space has become narrower than it should be, putting pressure on the nerves passing through. The narrowing is usually caused by age-related changes: thickening of ligaments, arthritis of the spinal joints, bulging discs, and the formation of bone spurs. These changes happen gradually, which is why symptoms typically develop slowly and worsen over time.
There are two main types based on location. Lumbar spinal stenosis affects the lower back, with leg pain or weakness on walking and standing, and is the most common type. Cervical spinal stenosis affects the neck and can include arm pain, hand weakness, balance problems, and in more severe cases walking difficulty from spinal cord involvement; cervical stenosis sometimes requires more urgent evaluation. PHI treats both.
How Spinal Stenosis Progresses
Spinal stenosis is a structural condition that typically progresses slowly. Most patients experience gradual worsening over years rather than rapid decline. Some remain stable for long periods; others find their walking distance shrinking from blocks to half-blocks to a few steps.
The progression is usually gradual enough to allow real decision-making about treatment timing. The honest part is that no current non-surgical treatment reverses the underlying narrowing. Treatments can manage symptoms and provide meaningful relief, sometimes for years, but they do not widen the spinal canal. Some patients can manage stenosis non-surgically for a long time; for others, surgery eventually becomes the right answer.
When to See Someone
Consider professional evaluation when your walking distance has been decreasing, when you are avoiding activities you used to enjoy because of leg pain or fatigue, when you experience leg weakness or numbness with walking or standing, or when symptoms are interfering with your daily life and independence.
Seek prompt evaluation if you experience new or worsening weakness in your legs or arms, loss of bladder or bowel control, difficulty with balance or coordination, or severe symptoms that develop suddenly or rapidly worsen. These can indicate more significant nerve or spinal cord involvement that requires urgent attention.
How PHI Treats Spinal Stenosis
The first step is an honest assessment of where you are. We evaluate your symptoms, review your imaging or recommend imaging if needed, and have a frank conversation about what non-surgical treatment can and cannot do for your specific situation.
For patients whose symptoms are driven significantly by inflammation around the compressed nerves, lumbar epidural steroid injections often produce meaningful relief lasting weeks to several months, and some patients manage stenosis for years with periodic injections combined with appropriate activity modification. For patients seeking to support the underlying spinal tissues, regenerative options including PRP, A2M, and exosome therapy may be appropriate in selected cases, though the evidence here is more limited and we discuss that honestly. For patients whose symptoms are severe and not responding to non-surgical treatment, modern decompression surgery can dramatically improve walking distance and quality of life; PHI does not perform lumbar decompression but coordinates with the spine surgeons we work closely with when that step makes sense.
Why PHI for Spinal Stenosis
Two board-certified pain physicians
Dr. Faisal Lalani and Dr. Nadiv Samimi both fellowship-trained at Cedars-Sinai and have extensive experience with spinal stenosis at all stages.
Convenient and affiliated surgery center
Image-guided injections are performed by PHI physicians in our affiliated surgery center.
Honest framing of what treatments can do
Spinal stenosis is a condition where realistic expectations matter. We tell you straightforwardly what injections are likely to provide, what regenerative options can and cannot offer, and when surgical evaluation makes sense.
Coordinated surgical referral
PHI does not perform lumbar decompression, but coordinates with the spine surgeons we work closely with when surgery is the right answer. Patients are not pushed toward either path.
Treats both lumbar and cervical stenosis
PHI evaluates and treats both lumbar and cervical spinal stenosis, with prompt attention when cervical symptoms suggest spinal cord involvement.
Concierge, coordinated care
Single-physician continuity from consultation through treatment and return to activity. Patients receive clear guidance and transparent pricing at consultation.
Frequently Asked Questions
Most patients experience gradual worsening over years. Some remain stable for long periods. The rate of progression varies significantly between individuals. Your physician can give you a more specific assessment based on your imaging and current symptoms.
No current non-surgical treatment reverses the underlying narrowing. Non-surgical treatments manage symptoms and can provide meaningful relief, sometimes for years, but they do not widen the spinal canal. Surgery is the only intervention that addresses the structural narrowing directly.
Injections are most effective for symptoms driven by inflammation around the compressed nerves. For patients with a strong inflammatory component, they often provide relief lasting weeks to several months. For patients whose symptoms are primarily mechanical compression, the response may be less robust. Your physician will give you a realistic estimate.
The decision typically depends on the severity of your symptoms, how they are affecting your life, and your response to non-surgical treatment. Patients with severe walking limitations, persistent symptoms despite injections, or progressive neurological changes are typically reasonable surgical candidates. The decision is yours, made with full understanding of what surgery can and cannot offer.
The most common surgery is a laminectomy or decompression, which removes the bone or tissue causing the narrowing. Some patients require fusion in addition to decompression. Modern minimally invasive approaches are available for many patients. The spine surgeons we work with can discuss specifics if surgery becomes the right next step.
Yes, often with modifications. Activities that involve forward bending, such as cycling, swimming, or walking with a cart, are typically more comfortable than activities that involve extension. Many patients benefit from working with a physical therapist who understands spinal stenosis.
Weight management can reduce the load on the spine and may improve symptom severity, though it does not change the underlying narrowing. Combined with appropriate exercise and treatment, it is often a useful component of long-term management.
As a concierge practice, PHI is out-of-network with all insurance plans, ensuring clinical judgment is never dictated by coverage decisions. All pricing is disclosed at consultation.
Contact our concierge team and we’ll coordinate your consultation and plan of care. Call (310) 856-9488 to discuss timing.
Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations.
Treatments We Offer for Spinal Stenosis
PHI offers evidence-based non-surgical treatments for spinal stenosis. Your physician will recommend the right option based on the location of your stenosis, the severity of your symptoms, and your goals. Surgical referral is coordinated when appropriate.
- Epidural Steroid Injections, often the first interventional step for inflammation-driven symptoms
- PRP Therapy
- A2M Therapy
- Exosome Therapy
Schedule Your Spinal Stenosis Consultation
A 60-minute consultation will evaluate your specific situation, walk through realistic treatment options, and give you a clear understanding of what to expect from each path. Call (310) 856-9488 or book online now.