Lumbar Stenosis
What Is Spinal Stenosis?
Spinal stenosis is a condition caused by the gradual narrowing of the spinal canal through which the nerves of the spinal cord travel.
This narrowing of the spinal canal can happen as a result of the degeneration of both the facet joints and the intervertebral discs. Bone spurs, called osteophytes, grow into the spinal canal. The facet joints can become arthritic and enlarge. The supportive ligaments of the spinal column, especially the ligamentum flavum, thicken with age further narrowing the spinal canal.
These processes narrow the spinal canal, they begin to impinge and put pressure on the nerves roots and spinal cord, creating the symptoms of spinal stenosis.
Stenosis (or Narrowing) may occur in 3 main places:
Central stenosis, where the spinal cord or cauda equina are located,
Lateral recess stenosis, in the tract where the nerve root travel before leaving the spinal canal
Foraminal stenosis, where the individual nerve roots leave the spinal column to travel to the rest of your body.
Some distortion of the spinal canal will occur in virtually every person as they age, but the severity of the symptoms will depend on the size of a person's spinal canal and the pressure on the nerves. The rate of deterioration varies greatly from person to person, and not everyone will feel symptoms.
Whilst the degenerative or aging process is the most common causes, there are some less common causes of stenosis. These include spondylolisthesis, calcium pyrophosphate crystal deposition, amyloid deposition, and spinal tumors.
What Are The Symptoms Of Spinal Stenosis?
Some people with degenerative disease of the lumbosacral spine may be totally asymptomatic, some may complain of mild discomfort in the low back, and others may not even be able to walk.
Patients who have significant spinal stenosis typically will begin to notice pain in the buttocks, thigh or leg that develops with standing or walking, and improves with rest. In some cases, a patient will complain of leg pain and weakness without having any back pain. More severe symptoms of the disorder include numbness, a tingling sensation and/or weakness in the legs.
Certain positions can alleviate the symptoms of spinal stenosis by relieving pressure on your nerves such as leaning over a walker or shopping cart. Some patients with spinal stenosis can ride a bike and walk up an incline or flight of stairs without any pain. However, if they are walking down an incline or flight of stairs their symptoms may be much worse.
The presentation and severity of the symptoms of spinal stenosis depends on the several factors, including the original width of the spinal canal, the susceptibility of the nerves involved, and the unique functional demands of the patient and the pain tolerance of each individual. If you experience extreme leg weakness (foot drop) or difficulty controlling your bladder or bowel function, seek medical help immediately
Who is Affected?
Stenosis affects both men and women and is most common between the ages of 50 and 70. It also may occur in younger people who are born with a narrow spinal canal or who experience an injury to the spine.
How Is Spinal Stenosis Diagnosed?
Myelogram
When you first experience pain, consult your family doctor. Your doctor will take a complete medical history to understand your symptoms, any prior injuries or conditions, and determine whether any lifestyle habits are causing the pain. Next a physical exam is performed to determine the source of the pain and test for any muscle weakness or numbness.
Your doctor may order one or more of the following imaging studies: X-ray, MRI scan, myelogram, CT scan, or arterial Doppler study. Based on the results, you may be referred to a neurologist, orthopedist, or neurosurgeon for treatment.
Magnetic resonance imaging (MRI) is a noninvasive test that uses a magnetic field to give a detailed view of the soft tissues of your spine. Nerves and discs are clearly visible. Along with nerve compression, an MRI can also detect bony overgrowth, spinal cord tumors, or infections.
Myelogram is a specialized X-ray where dye is injected into the spinal canal through. An X-ray or CT scan then records the images formed by the dye. Myelograms can show a nerve being pinched by a herniated disc, bony overgrowth, spinal cord tumors, and spinal abscesses. This test may be useful especially if you are unable to have an MRI.
What treatments are available?
Unfortunatelly there are no medications or physical treatments that can stop or cure spinal stenosis. Non-surgical treatment is the first step to controlling mild to moderate symptoms. If you have severe pain and significant difficulty walking, you may be offered a surgical treatment.
Nonsurgical treatments
Self care:
Using correct posture (see Posture & Body Mechanics) and keeping your spine in alignment are the most important things you can do for your back. The lower back (lumbar curve) bears most of your weight, so proper alignment of this section can prevent injury to your vertebrae, discs, and other portions of your spine. You may need to make adjustments to your daily standing, sitting, and sleeping habits. You may also need to learn proper ways to lift and bend. You may be able to slow down the progression of stenosis by not smoking and maintaining a weight that's appropriate for your height and body frame.
Physical Therapy:
The goal of physical therapy is to help you return to full activity as soon as possible. Physical therapists can instruct you on proper posture, lifting, and walking techniques, and they’ll work with you to strengthen your back, leg, and stomach muscles. They’ll also encourage you to stretch and increase the flexibility of your spine and legs. Exercise and strengthening exercises are key elements to your treatment and should become part of your life-long fitness. Check with your doctor before you begin any new exercise program.
Medication:
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen, ibuprofen, celecoxib or meloxicam may be recommended by your doctor to reduce inflammation and relieve pain. Along with this other pain relief medications may be indicated. Getting the right balance between relieving your symptoms and minimising medication sid-effects can be difficult for some patients and may take close work with your doctor.
Steroid injections:
This minimally invasive procedure is performed with x-ray guidance and involves an injection of corticosteroids like cortisone and a numbing agent into the spine. The medicine is delivered directly to the painful area to reduce the swelling and inflammation of the nerves. Repeat injections may be needed to achieve full effect. Duration of pain relief varies, lasting for weeks or years.
Surgical Treatments
Surgery for spinal stenosis involves decompression of the compressed spinal cord nerves. This may involve removal of the bony and soft tissue overgrowth to relieve pressure and pinching of the spinal nerves. Depending on your symptoms and the area of nerve compression this may also involve spinal fusion surgery.
Please click below for information on related surgical procedures
