Lumbar Stenosis

Lumbar stenosis refers to narrowing of the spinal canal in the lower back (lumbar) region which exerts pressure over the spinal cord resulting in low back and leg pain. Lumbar stenosis occurs due to the narrowing of the spinal canal or the neuroforamen, in the lower back region. Central canal stenosis occurs if the spinal canal is narrowed and foraminal spinal stenosis occurs due to constriction of the neuroforamen, on either side of the vertebrae.

Causes

Lumbar stenosis is most common in people above 50 years of age, as a consequence of aging and wear and tear of the spine. However, some patients are born with a narrow spinal canal (congenital spinal stenosis). Lumbar stenosis may also result from an injury or trauma to the lower back; however, trauma might have occurred months or years before the onset of the symptoms of stenosis. The common conditions that may cause spinal cord compression include bone spurs (osteophytes), ruptured discs, degenerative disc disease, and thickening of spinal ligaments.  

Symptoms

Some individuals with lumbar spinal stenosis may not experience any symptoms; however, the symptoms may develop gradually and worsen over time. The most common symptom of lumbar stenosis is mild to severe low back pain that may spread to the buttocks or the legs. The pain usually increases on walking and is relieved by rest or leaning forward. Radicular pain or radiculopathy refers to the pain that travels down the leg. Other symptoms such as difficulty in moving your low back, numbness or tingling sensation in the buttocks or legs, weakness in the legs, bladder and bowel problems, and rarely loss of function (paraplegia) may also occur.

Diagnosis

A diagnosis of lumbar spinal stenosis is usually based on the presenting signs and symptoms, medical history and a physical and neurological examination. In the physical examination, your muscle strength, reflexes, and sensations are evaluated. Your doctor may suggest imaging tests such as X-rays, CT scans, MRI scan or myelography to identify and locate the nerve compression.

Treatment

Non-surgical treatment is the initial line of management for a lumbar stenosis and commonly includes anti-inflammatory and pain medications, muscle relaxants, physical therapy, spinal injections, braces, spinal decompression, and acupuncture. Nonsurgical treatment options focus on relieving pain and associated symptoms. Your doctor may recommend a combination of two or more treatment modalities to increase the success of the treatment.

Surgery may be considered in patients with unstable spine or neurological deficit or persistent pain that fails to respond to conservative treatment. Surgery involves the removal or trimming parts of bone or soft tissue causing the compression. The aim of the surgery is to relieve the pressure over the nerves or spinal cord. There are several surgical procedures for the management of lumbar spinal stenosis, performed through minimally invasive techniques. The common surgical techniques include:

  • Decompressive laminectomy: It is a surgical procedure in which a portion of the bone or lamina causing pressure on the nerves is removed.
  • Laminoplasty: It is a surgical procedure performed to expand the size of the spinal canal and release the pressure over the spinal cord and nerve roots.
  • Foraminotomy: It is a surgical procedure performed to widen the neuroforamen to relieve pressure over the compressed nerves.
  • Instrumentation and fusion: Spinal Fusion is a surgical technique in which two or more vertebrae are joined, with the help of bone grafts and/or instrumentation. Spinal instrumentation is a method of stabilizing the spine after fusion with the help of implants such as rods, plates, screws, and interbody devices.

Your surgeon will discuss the surgical options as well as the associated risks and benefits and recommend the most appropriate option for you. Your doctor is a reliable resource to answer all your questions and help you understand the condition better.



HARVARD MEDICAL SCHOOL ASHPP PENN SIS AMA NASS aaPM&R ISASS - The International Society for the Advancement of Spine Surgery