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Lumbar Spinal Stenosis

Lumbar spinal stenosis is a common lower back problem that occurs when an abnormal narrowing of the spinal canal compresses the spinal cord.

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Lumbar spinal stenosis is a common lower back problem that occurs when an abnormal narrowing of the spinal canal compresses the spinal cord. The spinal cord connects the brain to nerves throughout the entire body. It sits within the spinal canal, which is a channel within the bones of the spine (vertebrae). When pressure is placed on the lumbar spinal cord, it can cause symptoms throughout the body, including the legs and feet. Lumbar spinal stenosis is mostly a degenerative condition that affects people who are typically age 60 and older.

 

What causes Lumbar Spinal Stenosis?

The most common cause of lumbar spinal stenosis is arthritis (inflammation of the joints) caused by the normal wear and tear of the spine that occurs as we age. Lumbar spinal stenosis can also occur for other reasons, including:

 

  • Bone spurs
  • Infection of the spine
  • A herniated vertebral disc
  • Injury or trauma to the spine

Lumbar spinal stenosis is common in individuals who play/have played these sports:

  • Baseball
  • Basketball
  • Dancing
  • Football
  • Gymnastics
  • Hockey
  • Soccer

Symptoms

Compression of the lumbar spine can cause a wide range of symptoms, including:

 

  • Stiffness of the lower back
  • Pain in the lower back that eases with leaning forward
  • Sciatica (pain that radiates down the leg)
  • Claudication pain (pain in the legs that can be worsened by walking or prolonged standing)
  • Occasional muscle cramping in the low back or in the legs

Symptoms of lumbar spinal stenosis can worsen over time. More serious symptoms of lumbar spinal stenosis include:

  • Numbness and tingling of the legs and/or feet
  • Loss of bowel and/or bladder function
  • Weakness of the legs

When to see a doctor

If you have symptoms of lumbar spinal stenosis, especially numbness, tingling, and/or weakness in the leg(s), make an appointment with an orthopedic surgeon. During your appointment, your doctor will ask you to describe your symptoms and will conduct a physical examination. Your doctor will look for tenderness in the lower back, range of motion in the lower back and legs, as well as neurological symptoms like weakness in the legs.

To make a diagnosis, your doctor may prescribe the following imaging tests:

  • X-rays
  • MRI
  • CT scan or a CT myelogram

Non-operative treatment

Symptoms of spinal stenosis typically resolve with conservative, non-operative treatments, such as:

  • Avoiding aggravating activities like high impact exercise like jogging
  • Non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen, for pain relief
  • Physical therapy to increase strength and mobility of the spine – a home exercise program that needs to be done every day generally involves comprehensive stretching, strengthening and balance work.
  • Chiropractic care is sometimes helpful
  • Steroid injections to reduce inflammation and relieve pain
  • If walking becomes difficult, you may have to use a cane or a walker for support
  • Some people like to try alternative treatments, such as acupuncture.

 

Surgical Treatment

If conservative treatments do not help relieve symptoms, or if symptoms worsen, your doctor will recommend surgery to take the pressure off of the spinal cord. Lumbar spinal stenosis can be treated using the following surgical procedures:

  • Percutaneous image-guided lumbar decompression (PILD): Also called minimally invasive lumbar decompression (MILD). Needle-like instruments are used to remove a portion of a thickened ligament in the back of the spinal column to increase space in the spinal canal and remove nerve root impingement. Only patients with a thickened ligament are eligible for this type of decompression.
  • Laminectomy: A portion of or all of the lamina (the part of the vertebral bone that protects the spinal cord) is removed to create space in the spinal canal. Laminectomy can also be performed to remove a bone spur, herniated disc, or a damaged disc to reduce pressure on the spinal cord.
  • Spinal fusion: Spinal fusion is performed in conjunction with a laminectomy when a patient needs stabilization of the spine–patients who have stenosis in more than one vertebrae. During a spinal fusion, a bone graft is placed where the lamina/vertebral disc originally was. The two (or more) affected vertebrae are then joined using a metal plate. Once the bone graft grows, the vertebrae are fused together.

Recovery

The time it takes to find relief from symptoms of spinal stenosis depends on the severity of the diagnosis as well as the treatment prescribed. There is no cure for spinal stenosis, and treatment involves managing symptoms. Patients with mild symptoms may find relief in just a few weeks using conservative treatment methods.

Patients who undergo surgery may need at least six months to regain full mobility of the spine. Following surgery, patients will need to stay in the hospital for two to four nights. You’ll be given specific instructions on limiting movement for the next few weeks and when to start a physical therapy program to help you regain mobility and strength of the lower back.

 

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