Lumbar Spinal Stenosis

Lumbar Spinal Stenosis 

Lumbar Spinal Stenosis caused by narrowing of the spinal canal.

Lumbar Spine

The lumbar spine is made up of five vertebral bodies in the lower back, where the spine curves inward toward the abdomen. It starts about five or six inches below the shoulder blades, and connects with the thoracic spine at the top and extends downward to the sacral spine. These nerves transmit sensations from the buttocks and lower extremities through the spinal cord to the brain and transmit motor signals from the brain to the lower extremities to produce movement of the legs, toes, and joints of the lower extremities.

Lumbar Spinal Stenosis

Lumbar spinal stenosis is a condition caused by narrowing of the spinal canal. This narrowing occurs when the growth of bone or tissue or both reduces the size of the openings in the spinal bones. This narrowing can squeeze and irritate the nerves that branch out from the spinal cord.

Causes

• Back injuries- Can both cause spinal stenosis or can worsen already existing low-level symptoms.
• Tumor growth- Can narrow the spinal canal, but the occurrence of spinal tumors is rare.
• Bone spurs- As cartilage deteriorates between the joints of the back, small bone growths, called bone spurs, or osteophytes, can develop. Bone spurs sometimes develop due to arthritis in the spine.
• Herniated discs- As the discs in the back deteriorate they can herniate, meaning the disc swells, bulges, or ruptures. When this occurs some of the disc material can protrude into the spinal canal. A herniated disc, while painful, doesn’t always cause lumbar spinal stenosis.
• Changes to ligaments- Changes can occur, especially to the ligamentum flavum, the ligament that runs along the inside of the spinal canal. This ligament can become thickened, taking up more space in the spinal canal. Or, as deteriorating discs lose some of their height, this ligament can buckle.
• Enlarged facet joints- Enlargement of the facet joints in the spine can also cause narrowing of the spinal canal.
• Spondylolisthesis- Refers to the forward slippage of one vertebra over another in the spine. This can cause narrowing of the spinal canal and result in pinching of the nerves. Learn more about spondylolisthesis.

Symptoms/Signs

• Back pain: People with spinal stenosis may or may not have back pain, depending on the degree of arthritis that has developed.
• Burning pain: Pressure on spinal nerves can result in pain in the areas that the nerves supply. The pain may be described as an ache or a burning feeling. It typically starts in the area of the buttocks and radiates down the leg. The pain down the leg is often called "sciatica." As it progresses, it can result in pain in the foot.
• Numbness: As pressure on the nerve increases, numbness and tingling often accompany the burning pain. Although not all patients will have both burning pain and numbness and tingling.
• Weakness or "foot drop": Once the pressure reaches a critical level, weakness can occur in one or both legs. Some patients will have a foot-drop, or the feeling that their foot slaps on the ground while walking.
• Pain with leaning forward or sitting: Studies of the lumbar spine show that leaning forward can actually increase the space available for the nerves. Many patients may note relief when leaning forward and especially with sitting. Pain is usually made worse by standing up straight and walking. Some patients note that they can ride a stationary bike or walk leaning on a shopping cart. Walking more than 1 or 2 blocks, however, may bring on severe sciatica or weakness.

Treatment

Surgery - Laminectomy

This procedure involves removing the bone, bone spurs, and ligaments that are compressing the nerves. This procedure may also be called a "decompression." Laminectomy is a surgical procedure to remove a portion of the vertebral bone called the lamina. The minimal form of the procedure requires only small skin incisions, the back muscles are pushed aside rather than cut, and the parts of the vertebra adjacent to the lamina are left intact. Recovery from the minimal procedure can occur within a few days.

Spinal fusion

If arthritis has progressed to spinal instability, a combination of decompression and stabilization or spinal fusion may be recommended. Spinal fusion is a surgical procedure used to correct problems with the small bones of the spine (vertebrae). It is essentially a "welding" process. The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone.

Lumbar traction

Although it may be helpful in some patients, traction has very limited results. There is no scientific evidence of its effectiveness.

Steroid injections

Cortisone is a powerful anti-inflammatory. Cortisone injections around the nerves or in the "epidural space" can decrease swelling, as well as pain. It is not recommended to receive these, however, more than 3 times per year. These injections are more likely to decrease pain and numbness but not weakness of the legs.

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