Lumbar stenosis develops when either the spinal canal or nerve passageways (foramen) become narrow. It is a common cause of low back pain. If the spinal canal is narrowed, the disorder is also termed lumbar central stenosis. If the foramen is narrowed, it is called lumbar foraminal stenosis. When either condition develops, the spinal cord and/or nerves are compressed. Sometimes, patients have both types of lumbar stenosis.
Some patients are born with this narrowing (congenital). However, most cases of lumbar stenosis develop in patients over age 50 and results from aging and wear and tear on the spine. Other common causes include osteoarthritis, degenerative disc disease, or bone spurs (osteophytes).
Symptoms
The symptoms of lumbar spinal stenosis include:
- Low back pain; not always severe
- Pain, weakness, or numbness in the buttocks or legs
- Difficulty and pain when walking, standing, or bending backwards.
- Pain relieved by resting or leaning forward
- Burning, tingling, and pins and needles sensations
- In severe cases, bladder and bowel problems
- Although rare, severe cases can cause loss of function or paraplegia
Diagnosis
Lumbar stenosis can be accurately diagnosed by an expert physician. The diagnostic procedure may include these steps.
- Medical history. Your doctor inquires about symptoms, their severity, what treatments you have already tried and the results.
- Physical examination. The physician will examine you for limitations of movement, balance problems, and pain. The physician will test your reflexes at the extremities and evaluate muscle weakness, loss of sensation, and signs of neurological injury.
- Diagnostic tests. Generally, doctors start with plain x-rays, which help rule out other problems, such as a tumor or infection. CT scans and MRIs may be performed to obtain more detail about your spinal problem, such as evidence of a herniated disc or osteophytes (bony growths). Sometimes, myelography is performed. Myelography involves injecting contrast dye into the spinal column to visually enhance areas where the spinal cord or nerve roots may be pinched.
Nonoperative Treatment
Many different nonsurgical treatments help relieve symptoms. These include:
- Medications, such as an anti-inflammatory to reduce swelling and pain, muscle relaxants to calm spasm, and occasionally, narcotic painkillers to alleviate severe pain.
- Cold/heat therapy, especially during the first 24 to 48 hours of pain onset.
- Spinal injections (i.e. epidural) may help relieve back and related lower extremity pain.
- Physical therapy, which may include gentle massage, stretching, therapeutic exercise, bracing, or traction to decrease pain and increase function.
- Alternative therapy (i.e. acupuncture).
As part of physical therapy, patients with lumbar stenosis will be educated in proper posture and body mechanics.
Surgical Treatment
If nonsurgical measures are not successful, surgery may be recommended.
There are different surgical techniques to treat lumbar stenosis. The goal of surgery is to decompress, or take pressure off the spinal cord and nerve roots. Decompression involves removing or trimming whatever is causing compression. Surgeons will discuss the various surgical treatment options and their associated risks and benefits with patients who may be candidates for surgery. A brief description of some of these operations follows.
- Decompressive laminectomy is a common surgical procedure to treat lumbar stenosis. This procedure removes the lamina (vertebral roof) to create more space in the spinal canal for nerves. If only part of the lamina is removed, the procedure is a decompressive laminotomy.]
- A discectomy removes part of, or an entire disc, such as a herniated disc that compresses nerve structures.
- Instrumentation and fusion are performed to stabilize the spine and may be combined with another procedure, such as discectomy. Instrumentation (i.e. screws, plates) and fusion (bone graft) joins and stabilizes two or more vertebrae.
This list is not exhaustive. Surgeons may advise patients about other types of procedures.
Surgical Recovery
Most patients begin to get out of bed the same day surgery is performed. Activity is gradually increased and patients are discharged home within a few days after their procedure, depending on the type and extent of the surgery. As with most surgeries, expect some pain after the procedure. Your doctor will provide pain medication to help keep you comfortable.
At home, you need to continue to rest. You are given instructions how to safely and gradually increase activity. Pain medications may be needed for a while. However, pain and discomfort should begin to reduce within a week or two after surgery. Information about other ways to reduce pain and increase flexibility will provided, along with instructions about when everyday activities may be resumed and, if appropriate, when the patient may return to work.
Conclusion
There are many safe and effective treatments for lumbar stenosis. Patients who suspect they have lumbar stenosis should seek out the services of an expert physician for accurate diagnosis and the most appropriate treatments.