Lumbar stenosis means that there is narrowing in the spine in the lumbar (back) area. The term stenosis simply means "narrowing" in medical terminology. The stenosis, or narrowing, can occur in the central spinal canal (which contains all of the nerve roots) or in the smaller openings around the spinal canal called the foramen (which contains a single spinal nerve root).
Lumbar Stenosis Causes
Most often, symptomatic spinal stenosis occurs because of the development of degenerative conditions. This is commonly related to age, genetics, and just wear and tear of daily living. There can be a congenital component to the stenosis. This typically involves the spinal canal and the lower lumbar spine. When someone has congenital stenosis, they are much more prone to develop symptoms from relatively small degenerative conditions such as disc herniations or bone spur formation. The stenosis can then lead to spinal nerve root compression, which lead to pain, numbness, or weakness.
Lumbar Stenosis Symptoms
Some people with lumbar stenosis are asymptomatic, meaning they suffer no adverse affects. The most common symptoms are:
- Leg pain
- Buttock pain
- Difficulty standing and walking for extended periods of time
- Feels better with sitting
- Heaviness in legs
- Low back pain
The pain may radiate like sciatica or may be a cramping pain. In severe cases, the pain can be constant. Depending on the level of compression, this pain may radiate down the back, sides, or front of the leg. Generally, pain increases with activity and as it progresses may force the individual to sit down to alleviate the symptoms. Often the pain will subside quickly and the individual may resume walking and their activity after several minutes. Sometimes persons may be able to walk farther with a cane or walker or using a grocery cart. This slight forward flexion of the spine will open the nerve foramen slightly and decrease overall impingement of the nerve.
There may be an associated burning or tingling with the pain, but rarely is there any motor deficit or weakness. In extreme cases, motor function and overall fitness may be impaired sufficiently to require the individual to use a wheelchair for locomotion. Bowel and bladder incontinence may also occur in the late stages of significant disease.
Who is a typical lumbar stenosis patient?
Most cases of lumbar spinal stenosis occur in patients over the age of 50.
Diagnosing Lumbar Stenosis
The disease itself is usually diagnosed initially by good historical evidence. Sometimes plain X-rays may show disc narrowing as well as facet hypertrophy or enlargement. Special oblique X-rays may show foramenal stenosis. Usually an MRI scan will be ordered to complete the diagnosis and identify the exact levels and extent of the compression. Sometimes, a CT myelogram is ordered in patients who cannot have an MRI or have implants that distort MRI images.
Nonsurgical Treatment of Lumbar Stenosis
Interventional treatments for lumbar stenosis may include:
- Physical therapy and/or exercises for exercises to help relieve the pressure on the nerve root
- Medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and pain and analgesics to relieve pain
- Epidural steroid injections and nerve root injections to help reduce swelling and treat acute pain that radiates to the hips or down the leg
Surgical Treatment of Lumbar Stenosis
Some of the surgical procedures used to treat lumbar stenosis at Emory are:
- Anterior Lumbar Interbody Fusion (ALIF)
- Extreme Lateral Interbody Fusion (XLIF)
- Lumbar Laminectomy with or without Spine Fusion
- Laminotomy
- Transforaminal Lumbar Interbody Fusion (TLIF)