Spontaneous Resolution of Severe Sciatica in Severe Multilevel Lumbar Spinal Stenosis – A Case Report Supporting Conservative Care

Spontaneous Resolution of Severe Sciatica in Severe Multilevel Lumbar Spinal Stenosis – A Case Report Supporting Conservative Care | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 9 February 2026 V1 Latest version Share on Spontaneous Resolution of Severe Sciatica in Severe Multilevel Lumbar Spinal Stenosis – A Case Report Supporting Conservative Care Author : Edoardo Cervoni 0000-0002-2558-2217 [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.177067441.11043581/v1 214 views 76 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Lumbar spinal stenosis (LSS) accompanied by radicular sciatica frequently leads to early recommendations for surgical intervention. Nevertheless, longitudinal evidence demonstrates that conservative approaches can yield substantial improvement, with nearly half of affected individuals achieving meaningful symptom resolution without operative treatment within 4–10 years. This case report describes the author's personal clinical journey, a 50-year-old lifelong athlete at the time of the symptoms onset, who developed sudden, incapacitating left-sided sciatica (VAS 10/10) caused by severe multilevel lumbar spinal stenosis, predominantly involving L4-L5 and L5-S1. Despite neurosurgical advocacy intervention, operative treatment was declined. Across a five-year period (2020–2025), symptoms gradually and spontaneously resolved through adaptive self-directed conservative management. This culminated in full return to high-intensity athletic performance, including pain-free gym training, football, weekly tennis participation, skiing, and unrestricted recreational exercise. This narrative explores mechanisms of neural plasticity, highlights potential risks associated with premature surgical intervention, and emphasises the importance of persistence and shared decision-making in carefully selected patients. Additionally, it proposes that graded exposure to physiological stress through continued physical activity may activate intrinsic repair processes, challenging deterministic views of degenerative spinal disease progression. Introduction Lumbar spinal stenosis (LSS) represents a degenerative spinal disorder characterised by narrowing of the spinal canal and neural foramina, often resulting in nerve root compression. Clinically, this commonly manifests as neurogenic claudication and radicular leg pain (sciatica) (Davis D et al. 2024). Epidemiological evidence from the Framingham Study demonstrates a prevalence of approximately 6.8% among individuals aged over 50 years, increasing to nearly 9% by age 70 (Kalichman L et al. 2009). The condition contributes significantly to functional impairment and reduced quality of life, frequently presenting with severe lower limb pain, sensory disturbances, and mobility restrictions (Ishimoto Y et al. 2013). Current clinical guidelines—including those published by the American Academy of Family Physicians and the North American Spine Society—recommend initial conservative management consisting of physiotherapy, pharmacological analgesia, and activity modification for a period of three to six months (Kreiner DS et al. 2013; Tomkins-Lane C et al. 2016). Surgical options such as decompressive laminectomy or spinal fusion are typically reserved for patients whose symptoms remain refractory to non-operative treatment. Outcome data, however, present a nuanced perspective. Surgical management can provide rapid symptom relief in approximately 70–80% of severe cases within the first two years (Jacobs WC et al. 2013). Yet long-term comparisons reveal that conservative treatment achieves comparable or superior functional outcomes in 50–60% of patients over 5–10 years, while avoiding surgical complications such as postoperative spinal instability, which occurs in 10–28% of cases, and reoperation rates that may approach 37.5% (Zaina F et al. 2016; Turner JA et al. 1992). Central to understanding conservative recovery is neural plasticity. Both the central and peripheral nervous systems demonstrate remarkable capacity for adaptation through mechanisms such as axonal regeneration, synaptic remodelling, and reduction of central sensitisation (Patel RK et al. 2022). These adaptive responses can transform acute neuropathic pain into tolerable or fully resolved states despite persistent anatomical abnormalities. Nevertheless, clinical decision-making frequently prioritises surgical correction, potentially exposing patients to iatrogenic instability without restoring native structural physiology (Nerland US et al. 2015). The present case, derived from a verified first-person clinical experience, illustrates the transformative potential of patience, resilience, and conservative management. It further proposes that graded physiological stress—akin to hormesis—may stimulate regenerative biological pathways, including autophagy within disc tissue and epigenetic modulation favouring neural repair (Battié MC & Videman T. 2006; Zaina F et al. 2016). Case Presentation The patient was a lifelong competitive athlete who had maintained a rigorous training regimen since the age of 18, involving five days per week of combined resistance training and cardiovascular conditioning. Over more than three decades of consistent high-intensity exercise, he experienced no prior spinal symptoms. At age 50, during early 2020, the patient developed sudden onset severe lower back pain with left-sided L5 radiculopathy while undertaking a routine park run during the COVID-19 pandemic. Gym closures earlier that year had forced a temporary transition from combined resistance and endurance training to running alone for several months. No identifiable trauma or precipitating injury occurred, and prior training sessions—including competitive races and heavy resistance exercise—had been entirely symptom-free. Symptoms escalated rapidly over several days. The patient described excruciating sciatic pain rated 10/10 on the visual analogue scale, radiating from the lumbar spine along the posterior thigh to the dorsum of the foot. Associated dysesthesia affected the first web space of the left foot, consistent with L5 dermatomal distribution. Functional impairment was profound. The patient was unable to sit upright during meals for approximately one month, instead eating while lying on the floor performing stretching manoeuvres. Car travel remained barely tolerable, although seat heating provided mild symptomatic relief. Walking capacity was limited to less than 100 yards before severe neurogenic claudication forced cessation. Occasional mild right-sided L5 sensory symptoms occurred but remained infrequent. Despite severe disability, the patient continued working as a general practitioner without taking leave from professional duties. Contrast-enhanced MRI performed several months later demonstrated advanced multilevel degenerative disc disease. Pathology was most pronounced at L4-L5 and L5-S1, showing bilateral foraminal narrowing, more severe on the left side, and moderate central canal stenosis at L4-L5. Radiological interpretation suggested impending severe stenosis, prompting urgent referral to neurology and neurosurgery for consideration of decompressive laminectomy with instrumented fusion. Figure 1: MRI showed extensive multilevel disc degeneration accompanied by pronounced spinal canal stenosis. The patient declined operative management, citing concerns regarding long-term biomechanical consequences and a strong belief in intrinsic adaptive recovery. Initial self-management strategies were intentionally minimalistic and largely non-pharmacological. Bed rest was strictly avoided to prevent deconditioning, in line with modern rehabilitation principles (Ammendolia C et al. 2018). Analgesic medication, including NSAIDs and paracetamol, was used sparingly, with fewer than four doses of each taken during the acute phase, aiming to preserve nociceptive signalling involved in physiological repair processes (Patel RK et al. 2022). No formal physiotherapy, cryotherapy, epidural injections, or structured rehabilitation programmes were undertaken. Recovery followed a gradual and non-linear course. Six months after onset, the patient regained limited tolerance for sitting during morning coffee. Approximately two and a half years after symptom onset, diurnal pain fluctuations diminished significantly, suggesting reduction in neurogenic inflammatory processes. This milestone allowed cautious reintroduction of gym-based resistance training. An early functional breakthrough occurred when the patient completed a 100-metre sprint—despite residual discomfort—to retrieve a takeaway pizza. While anecdotal, this episode symbolised transition from intolerable pain to manageable symptom negotiation, indicating reduced central sensitisation (Patel RK et al. 2022). Structured rehabilitation subsequently evolved through self-regulated graded exposure. Interval jogging alternating with walking gradually improved endurance. Progressive axial loading followed, eventually restoring capacity for 100 kg barbell squats by 2024. Cognitive reframing played a critical therapeutic role. Pain was interpreted as a protective neurobiological signal rather than evidence of irreversible damage, facilitating descending inhibitory control and cortical recalibration of pain processing. Five years following symptom onset, the patient achieved complete resolution of radicular pain, sensory disturbance, and functional limitation. He resumed competitive football on natural grass surfaces, performed 100 kg squats without discomfort, played weekly tennis, and engaged fully in high-intensity training exceeding pre-morbid performance levels. At no point were red-flag symptoms such as progressive motor weakness or sphincter dysfunction observed. Overall quality of life exceeded pre-injury baseline status. Discussion This case illustrates spontaneous resolution of severe lumbar spinal stenosis with radiculopathy, consistent with existing literature demonstrating sustained improvement in 40–60% of conservatively managed patients over 5–10 years (Zaina F et al. 2016; Nerland US et al. 2015). Importantly, these long-term outcomes often surpass surgical cohorts in durability while avoiding complications and revision surgery. Radicular symptoms frequently resolve within 6–12 weeks in many patients, though chronic stenotic pathology typically results in slower progression toward stabilisation (Patel RK et al. 2022). The patient’s extensive athletic background likely enhanced adaptive recovery mechanisms. Long-term strength and endurance training are known to improve paraspinal muscle integrity, vascular perfusion, and proprioceptive control, thereby reducing mechanical stress on compressed nerve roots and improving metabolic support for neural tissue (Ammendolia C et al. 2018; Zaina F et al. 2016). The temporary shift to running-only training during pandemic lockdowns may have altered spinal load distribution and unmasked latent degenerative changes. However, sustained cardiovascular activity likely prevented systemic deconditioning and preserved neurovascular resilience (Battié MC & Videman T. 2006). Minimal pharmacological intervention may also have contributed positively by preserving natural inflammatory and reparative signalling pathways. Endogenous anti-inflammatory cascades, including interleukin-10 mediated modulation, may have been preserved by limiting analgesic use (Patel RK et al. 2022). Understanding why progression halted despite radiological severity requires exploration beyond conventional models. Hormesis—the concept that low-dose stress stimulates adaptive biological responses—may offer explanation. Repetitive sub-threshold mechanical loading during graded exercise could promote mitochondrial biogenesis within Schwann cells and enhance metabolic activity within intervertebral disc endplates (Zaina F et al. 2016). Epigenetic adaptations resulting from lifelong physical training may have facilitated enhanced brain-derived neurotrophic factor expression, promoting neural remodelling and resilience (Patel RK et al. 2022). Even the seemingly trivial pizza sprint may have functioned as a behavioural threshold challenge, reducing nociceptive hypervigilance. Surgical variability further complicates risk-benefit assessment. Over-aggressive decompression may induce postoperative instability in up to 17% of cases (Nerland US et al. 2015). Conservative recovery avoids such structural compromise. For physically resilient patients without neurological red flags, sustained conservative management represents an active biological strategy rather than passive treatment delay. Large cohort investigations, including the SPORT trial, support the equivalence of long-term outcomes between surgical and conservative pathways (Jacobs WC et al. 2013; Peul WC et al. 2007). Limitations of this report include its single-case design. Future research should investigate biomarkers of hormetic adaptation in comparable patient populations (Tomkins-Lane C et al. 2016). Conclusion For patients confronting lumbar spinal stenosis accompanied by severe sciatica, perseverance may represent a powerful therapeutic tool. This personal clinical journey—from debilitating running-induced pain to full return to competitive sport—demonstrates that biological adaptation, given sufficient time and appropriate graded stress, can rival surgical intervention in selected cases. Shared decision-making remains essential. Patients and clinicians should carefully weigh the potential benefits of natural recovery against surgical risks. As both physician and patient, this experience reinforces trust in the body’s intrinsic capacity for repair. Question deterministic assumptions, remain open to adaptive potential, and recognise that resilience frequently reshapes clinical outcomes. References 1. Kalichman L, Cole R, Kim DH, et al. Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J. 2009;9(7):545-550. 2. Tomkins-Lane C, Melloh M, Lurie J, et al. ISSLS prize winner: consensus on the clinical diagnosis of lumbar spinal stenosis. Spine. 2016;41(15):1239-1246. 3. Kreiner DS, Shaffer WO, Baisden JL, et al. Evidence-based guideline for degenerative lumbar spinal stenosis. Spine J. 2013;13(7):734-743. 4. Jacobs WC, Rubinstein SM, Willems PC, et al. Surgical interventions for low back disorders. Eur Spine J. 2013;22(9):1936-1949. 5. Ammendolia C, Stuber K, de Bruin LK, et al. Nonoperative treatment of lumbar spinal stenosis. Spine. 2018;43(14):E825-E836. 6. Nerland US, Jakola AS, Giannadakis C, et al. Predictors of deterioration after decompressive surgery. World Neurosurg. 2015;84(4):1095-1102. 7. Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus nonsurgical treatment meta-analysis. Eur Spine J. 2016;25(2):385-396. 8. Davis D, Maini K, Sadiq TM. Lumbar spinal stenosis. StatPearls. 2024. 9. Turner JA, Ersek M, Herron L, Deyo R. Surgery for lumbar spinal stenosis meta-analysis. Spine. 1992;17(1):1-8. 10. Ishimoto Y, Yoshimura N, Muraki S, et al. Wakayama Spine Study. Osteoarthritis Cartilage. 2013;21(6):783-788. 11. Patel RK, Tank J, Patel V, et al. Neural mobilization systematic review. J Clin Med. 2022;11(10):2881. 12. Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus conservative treatment for sciatica. N Engl J Med. 2007;356(22):2245-2256. 13. Battié MC, Videman T. Lumbar disc degeneration epidemiology. J Bone Joint Surg Am. 2006. Information & Authors Information Version history V1 Version 1 09 February 2026 Copyright This work is licensed under a Non Exclusive No Reuse License. Keyword neuroplasticity Authors Affiliations Edoardo Cervoni 0000-0002-2558-2217 [email protected] View all articles by this author Metrics & Citations Metrics Article Usage 214 views 76 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Edoardo Cervoni. Spontaneous Resolution of Severe Sciatica in Severe Multilevel Lumbar Spinal Stenosis – A Case Report Supporting Conservative Care. Authorea . 09 February 2026. 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