Lumbar Spinal Stenosis
With age, our intervertebral discs become less spongy and fluid-filled, resulting in reduced disc height and bulging of the hardened disc into the spinal canal. Arthritis can cause the bones and ligaments of the spinal joints to thicken and enlarge, pushing into the spinal canal. These changes cause narrowing of the lumbar spinal canal, or spinal stenosis.
What are the Symptoms of Lumbar Spinal Stenosis?
Symptoms of lumbar spinal stenosis include pain, numbness, or cramping in the legs, with or without back pain. Weakness or heaviness in the legs may also occur. Bowel and bladder problems are rare. Symptoms are often worse with prolonged standing or walking and improved with bending forward or sitting down.
How is Lumbar Spinal Stenosis Diagnosed?
In addition to your symptoms, lumbar spinal stenosis can be diagnosed on physical exam by your primary care physician or neurosurgeon. Your physician may have you obtain diagnostic imaging to aid in confirming the diagnosis. For example, X-ray studies may be ordered that may reveal evidence of narrowed discs and/or thickened facet joints. A Magnetic Resonance Imaging (MRI) scan may be obtained for more detailed evaluation of spinal structures. These studies can provide information about the presence, location, and extent of spinal canal narrowing and nerve root pressure.
What is the Treatment for Lumbar Spinal Stenosis?
Depending on the severity of your symptoms, a course of non-surgical treatment may be prescribed by your primary care physician or neurosurgeon. This typically involves a combination of medications, physical therapy, and epidural steroid injections.
Medications that are typically prescribed include pain medications to help with your symptoms as well as anti-inflammatory medications, such as ibuprofen, to help decrease inflammation around the nerves in your spine. Occasionally other medications such as Lyrica and Neurontin are prescribed to help with nerve pain.
In addition to medications, a physical therapy program may be incorporated as a form of non-surgical treatment. A physical therapy program usually begins with stretching exercises to restore flexibility to tight muscles in the neck, trunk, arms, and legs. Depending on your response to physical therapy, stretching exercises may progress to cardiovascular exercise and strengthening exercises for your arms, legs, and trunk muscles.
Epidural steroid injections may also be prescribed and involve injection of corticosteroids into the area around your spinal cord and nerves in order to reduce inflammation.
If you fail to respond to non-surgical treatment, surgery may be recommended. This usually involves a lumbar laminectomy, which is removal of the bone and overgrown ligaments pressing on the spinal nerves. In addition, if there are any signs of instability or risk for creating instability with surgery, your neurosurgeon may perform a lumbar fusion, which involves placing screws, rods, and bone graft in order to fuse a part of your spine into one unit. Both of these procedures are typically performed with minimally-invasive techniques at Rush-Copley Neurosurgery.
Where Can I Find More Information?
North American Spine Society. (2009). Lumbar spinal stenosis.