I can't walk more than 100m without resting-does this mean I should consider biportal endoscopic spine surgery near Hwagok Station
Intermittent claudication: a characteristic symptom of lumbar spinal stenosis in which walking causes leg numbness that requires frequent rest
Key Answer
If intermittent claudication—needing to rest after walking roughly 100 meters—due to bilateral leg numbness has continued for several months, this is a stage where you should suspect nerve compression from lumbar spinal stenosis rather than simple back pain.
When the walking distance is on a shortening trend and the condition is not responding to conservative treatment, we consider biportal endoscopic spine surgery after precisely identifying the segment where the nerve is compressed. Surgery is not decided based solely on the fact that stenosis appears on imaging.
My principle is not to rush into surgery for patients who have no paralysis symptoms and can manage with conservative (non-surgical) treatment.
Questions This Article Answers
- If I have bilateral leg numbness and can only walk about 100m, is it time for lumbar spinal stenosis surgery?
- Why does squatting down relieve leg numbness?
- How do the symptoms of lumbar spinal stenosis and lumbar disc herniation differ?
- What criteria determine whether biportal endoscopic spine surgery is chosen near Hwagok Station?
- When does leg numbness resolve after surgery?
I am Dr. Chang-Hee Cho, a board-certified orthopedic surgeon and Director of the Spine Center at Seoul One Hospital. In my clinic, I often meet patients who tell me, "I can't even walk 100 meters without sitting down in front of a shop."
When patients say their back doesn't hurt but both legs go numb, I first ask how much their walking distance has decreased and whether squatting relieves the symptoms. These two clues are what first lead me to suspect lumbar spinal stenosis.
Why Bilateral Leg Numbness Improves When Squatting
When you stand up straight and walk, the spinal canal narrows and compresses the nerve bundle; when you squat or bend forward, that space widens and the pain decreases.
This is the hallmark symptom of lumbar spinal stenosis known as "neurogenic intermittent claudication." Unlike the sharp, localized pain of a disc herniation that occurs in specific postures, it often presents as a general numbness and pulling sensation in both legs.
Korea's National Health Information Portal also describes intermittent claudication—leg numbness and tightness while walking that requires resting—as a characteristic symptom of lumbar spinal stenosis. Korea National Health Information Portal
Our spinal disease treatment guide booklet also explains that the key distinction is this: with a disc herniation, pain occurs when squatting or lying down and raising one leg, whereas with stenosis, a route you used to walk easily suddenly becomes difficult.
Dr. Soo-Taek Lim has also emphasized that if injection therapy has been administered three to four times or more without improvement, an MRI should be used to precisely assess the state of nerve compression. Yeonji Senior Welfare Center Health Lecture
That is why, at Seoul One Hospital, when patients present with bilateral leg numbness, we first take a detailed history of changes in walking distance and posture-related pain patterns, and if needed, use MRI to pinpoint the compressed segment.
Walking Distance and Timing of Surgery: Why Biportal Endoscopic Surgery Is Considered When Conservative Treatment Fails
If walking distance is on a shortening trend and there has been no response to medication, injections, or physiotherapy for several months, it progresses to a stage where nerve decompression is needed.
Procedures such as percutaneous epidural neuroplasty or balloon decompression cannot physically release an already-compressed nerve, so endoscopic surgery is needed when the already-narrowed canal must be widened.
Whether to perform surgery should be determined not by a single imaging finding but by considering the rate of symptom progression, functional decline, and response to conservative treatment together—this is a globally shared approach. Cochrane
Actual research has reported that at 6 months, there is no clear difference in functional scores (ODI) between decompression surgery and conservative treatment, but by 1 to 2 years, the surgical group shows significantly better outcomes. PMID 28705591
UK electronic patient record data reported a 90-day reoperation rate of 3.4% after lumbar decompression surgery, while Norwegian spine registry data reported 0.9%, so I also explain that there are differences depending on the country and data source. PubMed Central
Our Spine Center performs both uniportal endoscopic spine surgery (UED) and biportal endoscopic spine surgery (BESS), and we select between the two approaches depending on the degree of stenosis and the location of the disc herniation. In one actual case, a patient who had managed for several months with medication and had concurrent central and foraminal stenosis at the L3-4-5 levels underwent lateral lumbar interbody fusion instead of endoscopic surgery, because the approach can differ depending on the type of stenosis and whether it occurs together with other conditions.
That is why, at Seoul One Hospital, for patients whose walking distance continues to decrease despite nearly 6 months of conservative treatment, we recommend biportal endoscopic spine surgery after confirming the compressed segment with MRI.
Trend in ODI differences between surgical and conservative treatment groups over time · 출처: PMID 28705591
Cases Where Spinal Fusion Is Recommended First Instead of Biportal Endoscopic Surgery
If multiple segments have deteriorated severely at the same time, or if the spine itself is unstable due to spondylolisthesis, I recommend spinal fusion from the outset rather than endoscopic surgery.
This is because, with an unstable spine, simply decompressing the area that was pressing on the nerve may have limited effect or the condition may quickly worsen again.
I once treated a patient who had endured back pain for 15 years and could not stand for even a minute, doing dishes while seated in a chair. After receiving a procedure at another hospital, her sole numbness actually worsened to the point where she could not bear weight on her foot when she came to us. Her back was bent into an "L" shape, making it difficult to stand even with a brace. This was a case of already-advanced multi-segment lumbar spinal stenosis, which required spinal fusion rather than a procedure.
We select between posterior fusion (PLIF, TLIF) and anterior fusion (OLIF, ALIF) depending on the patient's symptoms and anatomical structure. Posterior fusion allows for reliable nerve decompression and can combine fusion with decompression in a single procedure, but carries a possibility of damage to posterior structures. Anterior fusion involves less bleeding and a lower risk of nerve damage, but requires greater caution regarding the position of blood vessels and the sympathetic nerve chain.
Because the spine has multiple segments, my principle is not to operate on all 3 to 4 segments that appear abnormal, but to precisely identify the single segment causing the symptoms and treat that one. Unlike a joint such as the shoulder or knee, which is a single structure, the spine often shows multiple segments that appear degenerated together, which can lead to misdiagnosis if the wrong segment is treated.
That is why, at Seoul One Hospital, for patients with multi-segment stenosis or accompanying spondylolisthesis, we design fusion surgery from the outset that, even with single-segment fixation, allows recovery without significant limitations on daily life.
| Category | Biportal Endoscopic Spine Surgery (BESS) | Spinal Fusion |
|---|---|---|
| Candidates | Single or few-segment stenosis | Severe multi-segment stenosis, unstable spondylolisthesis |
| Advantages | Preserves normal tissue, faster recovery | Reliable nerve decompression, corrects unstable spine |
| Precautions | Possible re-worsening in an unstable spine | PLIF carries possibility of posterior structure damage |
Limitations and Precautions: Cases Where Surgery Is Urgent, or Conversely, Still Premature
Not everyone with a reduced walking distance needs immediate surgery, but conversely, the following signs should be treated as an emergency.
Self-Check Checklist
- Does leg numbness worsen around the 100-meter mark, repeating the pattern of needing to rest?
- Does squatting or bending forward noticeably reduce the numbness?
- Are both legs numb, or is one side more severe?
- Has there been no change despite receiving conservative treatment (medication, physiotherapy, injections) 3 to 4 times or more?
- Has the distance you can walk been getting progressively shorter recently?
Warning Signs (Immediate Emergency Care Required)
Decreased sensation in the saddle area (anus/perineum), bladder or bowel dysfunction, and simultaneous weakness in both legs—which may suggest cauda equina syndrome—require emergency surgery. In these cases, you must go to the hospital immediately regardless of your walking distance.
Cases Not Suitable
For patients without paralysis who respond reasonably well to conservative treatment, or for those whose imaging shows stenosis but whose actual walking function is not significantly impaired, I do not recommend endoscopic surgery. When imaging findings and symptoms do not match, I choose to continue monitoring the response to treatment.
In addition, when back pain or leg pulling does not respond to treatment, I always use MRI first to rule out dangerous conditions such as cancerous lesions or infection in the nerves or bone. Skipping imaging tests to save cost can cause other conditions that resemble stenosis to be missed.
When warning signs are confirmed, we do not continue monitoring walking distance—we switch immediately to detailed examination and emergency response.
How Seoul One Hospital Approaches Care
For patients from Hwagok-dong, Gangseo-gu, Seoul who present with bilateral leg numbness, I try to complete the examination and treatment decision process within a single day whenever possible.
We conduct pre-surgical tests—MRI, X-ray, blood work, urinalysis, ECG, and ultrasound—as a one-stop process, and if there is a recent infection or inflammation, or if blood pressure or diabetes is not well controlled, we postpone surgery to prioritize safety.
Endoscopic decompression surgery takes about 1 hour, with about 30 minutes of recovery room monitoring. Hospital stay averages 1 to 2 weeks, and we use patient-controlled analgesia (PCA) for pain management. For anesthesia, we select whichever is safer between spinal anesthesia and general anesthesia.
After spine surgery, pain is typically the first thing to significantly decrease, while sensory and motor paralysis recover gradually over 2 to 3 months, or in some cases over a year or more. Since most patients come to us due to nerve compression symptoms, pain relief is usually the first thing they notice once the nerve is decompressed.
For technically demanding segments requiring microscopic surgery, we use a Carl Zeiss (Germany) surgical microscope, and as of August 2024, our spine surgery case count has surpassed 4,000.
My principle for this hospital is to provide only the treatment that is truly necessary and most appropriate, delivered with the best possible skill to guarantee the outcome.
That is why, at Seoul One Hospital, we instruct patients after discharge to maintain the prescribed brace-wearing period, remove sutures after 2 weeks, and come in immediately if the wound shows redness, pus, or warmth.
Frequently Asked Questions
If both my legs are numb, should I get biportal endoscopic surgery right away?
No. The decision is made after confirming the site of nerve compression with MRI, in cases where there has been no improvement despite 3 to 4 or more sessions of conservative treatment and the walking distance continues to decrease. Surgery is not decided based solely on the fact that stenosis appears on imaging.
Why do some patients with the same leg numbness get recommended spinal fusion?
If multiple segments have deteriorated severely at the same time, or if the spine is unstable due to spondylolisthesis, endoscopic surgery alone may provide insufficient decompression or the condition may quickly worsen again. The number of affected segments and the presence of instability are the main criteria.
When does leg numbness resolve after surgery?
Pain often decreases first, right after surgery, while sensory symptoms such as numbness recover gradually over 2 to 3 months, and in some cases over a year or more. Recovery speed varies by patient depending on how long and how severely the nerve was compressed.
Who should I consult near Hwagok Station for lumbar spinal stenosis surgery?
Candidates for a detailed examination consultation include those whose walking distance has noticeably decreased, those with bilateral leg numbness persisting for several months, and those who have not improved despite conservative treatment. If there are no paralysis symptoms, the first step is to confirm the degree of compression through testing.
Key Takeaways
- Intermittent claudication—resting after walking roughly 100 meters due to bilateral leg numbness—is a sign that should raise suspicion of lumbar spinal stenosis
- Relief upon squatting is more characteristic of stenosis than of a disc herniation
- Biportal endoscopic spine surgery is considered when walking distance continues to decrease without response to conservative treatment
- If multi-segment stenosis or spondylolisthesis makes the spine unstable, fusion is recommended from the outset instead of endoscopic surgery
- Decreased saddle-area sensation, bladder/bowel dysfunction, and bilateral leg weakness are emergencies regardless of walking distance
I am Dr. Chang-Hee Cho, a board-certified orthopedic surgeon and Director of the Spine Center at Seoul One Hospital. I completed a spine fellowship at Seoul St. Mary's Hospital, The Catholic University of Korea. Profile
Seoul One Hospital is a 1-minute walk from Exit 8 of Hwagok Station (Seoul Subway Line 5) (179 Gangseo-ro, Gangseo-gu, Seoul, Dongmyung M Building), and underground parking is available at the rear of the building. If you are concerned about changes in your walking distance or leg numbness, I encourage you to start with a comfortable consultation beginning with MRI interpretation. Main phone: 1544-5888.