Lumbar Spinal Stenosis
What is Lumbar Spinal Stenosis?
As we age, our bodies change. Lumbar spinal stenosis occurs when age-related changes to the bones, discs, muscles, and ligaments in the spine put pressure on the spinal canal causing it to narrow and obstruct and crowd nerves in the lumbar spine. This will cause chronic back pain and pressure. (The word stenosis is derived from the Greek word meaning “choking.”) The lumbar spine is the lowest part of the spinal cord and is surrounded by the hips, buttocks and lower back. Lumbar spinal stenosis usually develops later in life and affects people who are over the age of 50.
Symptoms of Lumbar Spinal Stenosis
As the nerves in the lower spine are compressed, they typically cause:
- Leg pain while standing.
- Extreme leg pain while walking that goes away immediately after sitting down.
- A tingling and/or numb sensation from the lower back through the buttocks and legs.
The symptoms of lumbar spinal stenosis come and go. If you are diagnosed with this condition, you may experience periods of extreme pain and discomfort and then other periods during which you are pain-free.
HOW IS LUMBAR SPINAL STENOSIS DIAGNOSED?
Based on your age and symptoms, if your doctor suspects lumbar spinal stenosis, he or she will probably order an MRI or CT scan to confirm the diagnosis. These scans will also help your doctor identify the specific type of stenosis you have. The three main types are:
- Central stenosis. Compression of the bundle of nerve roots at the bottom of the spinal cord.
- Foraminal stenosis. Compression of a nerve root that is also trapped by a bone spur where the nerve root leaves the spin
- Lateral stenosis. Compression of a nerve root by a building or herniated disc, or bone protrusion. This is the most common type of spinal stenosis.
TREATMENTS FOR LUMBAR SPINAL STENOSIS
The severity and duration of lumbar spinal stenosis vary from person to person. In some people, the condition is progressive (meaning that it becomes worse over time.) In other people, the condition never progresses to a severe case. Doctors will tailor their treatment recommendations accordingly. Often, doctors recommend a combination of the following non-surgical treatments:
- Modifying their activity. Because symptoms are more pronounced during walking and standing upright, doctors may recommend leaning slightly forward on a cane or walker to ease the pain.
- Exercising regularly. Because inactivity can worsen spinal conditions, doctors often recommend patients follow a safe exercise program created and monitored by a physical therapist.
- Taking medications. Non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen help with inflammation that’s often associated with spinal stenosis.
- Getting epidural steroid injections. Injecting steroids into the spine does provide symptom relief. The results are temporary, so patients must return for regular injections to achieve continued pain relief.
- Having minimally invasive lumbar decompression (mild®) treatment. mild® is one of the only spinal treatments specific to lumbar spinal stenosis. Guided by X-ray imagery, a spine surgeon makes a small incision in the back and uses small instruments to remove the part of the spine that’s putting pressure on the nerves. Patients who receive mild® treatment are discharged and able to walk the same day.
- Having spine surgery. In the most extreme cases of lumbar spinal stenosis when other treatments have failed and symptoms are debilitating and significantly limiting a patient’s quality of life, a spine doctor may recommend laminectomy surgery to remove the narrowed portion of the spine. This is a major surgery requiring a hospital stay and recovery period up to 6 weeks, so it is typically recommended only as a last resort. Fortunately, the success rate for patients who do have surgery to alleviate lumbar spinal stenosis pain is very high.