The lumbar spine is made up of five vertebral bodies in the lower back. Nerves coming off the spinal cord travel though the spinal canal and exit the canal through small openings on the sides of the vertebral called foramen. Lumbar stenosis is a condition in which either the spinal canal (central stenosis) or vertebral foramen (foraminal stenosis) becomes narrowed. If the narrowing is substantial, it causes compression of the nerves which cause the painful symptoms.
Alternative Names of Lumbar Stenosis : Spinal stenosis
Complications of Lumbar Stenosis
If left untreated the compression on the nerves from lumbar spinal stenosis can lead to increasing weakness and loss of function of the legs.
It can also lead to loss of bowel and bladder control.
Loss of sexual function.
Causes of Lumbar Stenosis
The main causes of lumbar spinal stenosis are :
Congenital : Lateral recess stenosis is most commonly acquired.
Acquired : The causes of acquired stenosis include :
a) Hypertrophy or enlargement of the facet joints (joints that connect adjacent vertebrae).
b) Hypertrophy of the ligamentum flavum (yellow ligament that connects adjacent vertebrae).
c) Disc protrusion.
Combination - Combination of both congenital and acquired factors.
Signs & Symptoms of Lumbar Stenosis
The lower back pain can be located on one side or both.
It can occur in the buttocks, thighs and lower legs.
The pain (or in some cases discomfort or numbness and tingling) often worsens with walking or prolonged standing.
The pain may be relieved by rest.
Sitting, squatting and bending forward at the waist may all help relieve the symptoms. The standing time and walking distance to symptom appearance may vary. It can take anywhere from a few minutes to half an hour for relief to occur.
Diagnosis of Lumbar Stenosis
Study of patients's medical history.
Physical examination. It is important to distinguish a spinal problem from a vascular (blood vessel) problem. The symptoms are similar. A check of the pulses in the legs and feet may be helpful. In some cases, testing of the circulation in the legs may be necessary to distinguish a spine problem from a vascular problem.
MRI scanning for the spinal problem.
In some cases, myelogram and post-myelogram CT scanning may be needed.
Flexion and extension (bending) x-rays may also be helpful in determining whether or not a fusion will be necessary.
Electromyography and nerve conduction velocity testing (EMG/NCV) may be conducted.
Treatments of Lumbar Stenosis
Non-Surgical Procedure : The initial treatment of lumbar spinal stenosis is non-operative. It may include a trial of non-steroidal anti-inflammatory medications and a short course of physical therapy. In some cases, a trial of epidural steroid injections may be given.
Surgical Procedure : If non-surgical procedure is unsuccessful in relieving symptoms then surgery may be considered. The most common surgical treatment for lumbar spinal stenosis is a laminectomy. This is an operation that involves the removal of the back portion of the spine to allow more room for the nerves. Depending on the particular situation, more or less bone may be removed. In some cases, particularly where spondylolisthesis is involved, a fusion procedure may be performed at the same time as the decompression. The surgical decision is indvidual specific.
Prevention of Lumbar Stenosis
The degenerative changes responsible for lumbar spinal stenosis can occur as part of the normal ageing process. There is little that can be done to prevent lumbar spinal stenosis.
When to seek Medical Advice
Pain in lower back, buttocks, thighs and lower legs.
Increase in pain while walking or prolonged sitting.