Lumbar Stenosis

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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

Video: Spinal Stenosis
Click below to view a video from our library about this condition.

Diagnosis

Lumbar spinal stenosis is often diagnosed by a spine specialist.

• Medical History 
  The physician asks you about your symptoms, their severity, onset, and treatments you tried.

• Physical Examination
  Movement limitations and problems with balance are evaluated.  He tests your reflexes, muscle strength, sensation, and signs of neurologic dysfunction.

• Diagnostic Tests
  Generally, tests 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.

Non-operative Treatment

• Medications: anti-inflammatory drug 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.
• Spinal injections (i.e., lumbar epidural) may help relieve back and related lower extremity pain.
• Physical therapy: gentle massage, stretching, active exercise
• 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 non-surgical therapies are not successful, surgery may be recommended.
 

There are different surgical techniques to treat lumbar stenosis.  The goal of surgery is to decompress -- take pressure off the spinal cord and nerve roots. Decompression involves removing or trimming whatever is causing compression. The surgeon tells you about your surgical treatment options, and benefits and risks.  Surgery may include:
 

• Decompressive laminectomy removes the lamina (vertebral roof) and creates more room for nerve structures.  When part of the lamina is removed, the procedure is a decompressive laminotomy.

• Discectomy removes all or a part of an intervertebral disc to decompress the spinal cord and/or nerve roots.
   
• Instrumentation and fusion stabilize the spine.  Instrumentation involves the use of screws, rods, cages, or plates to immediately stabilize the spine.  Fusion is bone graft.  Bone graft is pack into and around the instrumentation; it stimulates new bone growth between two or more vertebral bodies.

There are other types of surgical procedures to treat lumbar spinal stenosis.

Surgical Recovery

Most patients begin to get out of bed the same day surgery is performed.  Activity is gradually increased and most patients are discharged home within a few days after their procedure, depending on the type of the surgery.  Post-operative pain should be expected.  Your doctor provides pain medication to help keep you comfortable.

At home, you need to rest.  You receive instructions about how to safely and gradually increase activity.  Pain and discomfort should begin to reduce within a week or two after surgery.

Conclusion

If back and leg pain is progressive and/or affecting your mobility, speak with a spine specialist about safe and effective treatment of lumbar spinal stenosis.