What Is Lumbar Stenosis?
Lumbar stenosis is narrowing of the spinal canal in the lower part of the spine (low back region). Stenosis means there is less room for the spinal cord and nerves, and this narrowing can place pressure on the spinal cord and/or nerves. While some patients have congenitally narrow spinal canal, most cases of lumbar stenosis occur as a result of “wear and tear” in the spine as patients get older, typically starting in their 50’s.
Most likely, genetics play a role since only a minority of individuals develops advanced spinal stenosis. The ligaments of the spine can thicken and harden (calcification). Bones and joints may also enlarge, and bone spurs (osteophytes) may form. Bulging or herniated disc are common as well. Slipping of one vertebra on top of another (spondylolisthesis) may be seen and lead to further compression of nerves.
Signs and Symptoms
Some of the symptoms of lumbar stenosis include:
- Low back pain that is worse when standing upright and better when bending forward or sitting
- Pain, weakness, or numbness in the buttocks and sometimes going down the legs and calves
- Burning sensation, tingling, or pins and needles in the involved leg
- Loss of bladder and bowel control in severe cases
- Complete or near complete loss of function in the legs (paraplegia) in the most severe and rare cases
Diagnosis
Dr. Cho performs a thorough examination during your initial visit that includes the following. He will ask you about your symptoms and their severity, what makes the symptoms better or worse, and what treatments you have already tried. A careful musculoskeletal and neurologic exam will consist of analyzing your gait and balance, leg strength, sensation and reflexes, as well as special maneuvers to study certain neurologic function. Dr. Cho will often order x-rays, CT scans, and/or MRI of your back and carefully review them with you.
Non-surgical Treatment
There are a number of non-operative treatments that can help relieve symptoms. Being educated about healthy back posture and proper body mechanics is important. Medications such as anti-inflammatories or muscle relaxants can alleviate the pain. Physical therapy along with therapeutic exercises can decrease pain and increase function. Various modalities (cold/heat therapy for example) can be helpful. Epidural steroid injections or nerve root blocks may be recommended when there is a pinched nerve.
Surgical Treatment
Surgery may be recommended when:
- Non-surgical treatments do not relieve pain.
- Pain goes down the leg (radiculopathy).
- There is loss of sensation or strength in the legs.
- There is loss of bowel or bladder control.
The goal of surgery is to safely take the pressure off the spinal cord and nerve roots. Dr. Cho will perform the surgery from the back of the spine (posterior approach). Removing the lamina (roof of the spine) and whatever else is pressing on the nerves and causing pain and damage is called decompression. Removing bone to create more room for the spinal nerves can make the spine unstable, and in that case, fusion may be required. Dr. Cho uses appropriate spinal implants (rods, screws, etc.) to immbolize the spinal segments as they fuse and heal.
For more details regarding surgery, please refer to Posterior Lumbar Spinal Instrumented Fusion.