LUMBAR SPINAL STENOSIS
Lumbar spinal stenosis is a narrowing of the spinal canal located inside the vertebrae of the lower back, known as the lumbar vertebrae. As this canal becomes narrower, it can put pressure on the spinal cord and nerves around it, causing lower back pain and leg pain, as well as numbness, tingling, and weakness in the legs.
While most people aren’t severely disabled, lumbar spinal stenosis can cause pain, numbness or weakness, most often in the legs, feet, and buttocks.
Lumbar Spinal Stenosis
Southwest Scoliosis Institute’s orthopedic surgeons, Richard Hostin, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, all board-certified, fellowship-trained surgeons with years of experience treating patients with complex spine conditions – including lumbar spinal stenosis.
Lumbar spinal stenosis primarily affects adults (50 years old and older) and is usually the result of normal age-related causes like wear and tear, arthritis, or a combination of both. Other conditions that can lead to lumbar spinal stenosis include:
- Lumbar disc herniation
- Degenerative scoliosis
- Spondylolisthesis (in which one vertebra slips over the one beneath it)
- Bone spurs
- Injuries to the vertebrae and/or disc(s)
- Spinal tumors
- Previous spine surgery
Lumbar spinal stenosis can occur with and without symptoms, but when symptoms do occur, they tend to worsen over time. The most common symptoms include:
- Back pain
- Pain radiating down into the buttocks and legs (sciatica)
- Numbness or tingling sensation in the legs and/or feet
- Muscle weakness in the legs and/or feet
Often, the pain and other symptoms associated with lumbar spinal stenosis decrease when sitting or leaning forward, and it will usually get worse when standing up straight and walking.
In severe cases, a lumbar spinal stenosis can lead to a loss of bladder or bowel control. While this is rare, it can be an indication of a serious condition known as cauda equina syndrome that requires immediate medical attention.
Diagnosis and Testing
Your physician at Southwest Scoliosis Institute will look carefully at your medical history before performing a thorough physical examination, during which they will specifically look for any signs of limited mobility and/or pain in the lumbar spine. The physician will also look for any difficulty balancing, as well as any reductions in muscle reflexes, loss of sensation, or muscle weakness that may be the result of the spinal cord being compressed by the disc.
If the physician suspects you have lumbar spinal stenosis, they will confirm this through a combination of X-ray imaging, computed tomography (CT) scans, or magnetic resonance imaging (MRI). X-rays can show whether there is an issue with the bones of the spine, such as bone spurs, loss of bone height, or spondylolisthesis, but CT and MRI scans are usually necessary to determine if there is a problem with the soft tissue of the spinal cord and surrounding nerves.
Southwest Scoliosis Institute uses an advanced digital low dose radiation X-ray imaging system that can take high-quality images of patients in just seconds. This system can also capture X-rays of patients while in a standing or seated position, and it’s conveniently located inside our Dallas location, meaning you and your physician can review the X-rays immediately after they are taken.
Treatment for Lumbar Spinal Stenosis
Not all patients with lumbar spinal stenosis will require surgery, and often their condition can improve with the help of nonsurgical treatments. In addition to managing pain and inflammation with non-steroidal anti-inflammatory drugs (NSAIDs), your physician at Southwest Scoliosis Institute may recommend physical therapy and/or exercises specifically designed to strengthen the muscles in the back and stabilize the spine. Your physician may also discuss using epidural steroid injections to decrease swelling in and around any affected nerves.
On your first visit to a back specialist, the initial determination that must be made is the seriousness of the problem. Some problems need immediate attention-possibly even surgery. The vast majority of back problems do not require surgery. Spinal stenosis is a slowly progressive back problem that may respond to conservative care.
A variety of treatment options exists for spinal stenosis. In most cases, simple therapies such as mild pain medications and rest are effective in relieving the immediate pain. Physical therapy may be beneficial if symptoms are not relieved with simple measures. The overall goal of treatment is to make you as comfortable as soon as possible and to get you back to normal activity in a timely manner.
Mild pain medications can reduce pain when taken properly. The medications will not cure or stop the progression of the problem, but they will help with pain control.
If your condition is causing only mild symptoms and does not appear to be getting worse, your doctor may have you work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.
Positions, movements, and exercises are prescribed to reduce pain. Treatments may also include lumbar traction to gently stretch the low back, easing pressure on the spinal nerves. Exercises are used to improve cardiovascular fitness and to tone the low back and abdominal muscles. Therapy sessions may be scheduled two to three times each week for up to six weeks.
The goals of physical therapy are to help you:
- learn to manage your condition and control symptoms
- learn correct posture and body movements to reduce back pain
- maximize flexibility and core strength
- foster heart and lung fitness
An epidural steroid injection (ESI) can be used to relieve the pain of stenosis and irritated nerve roots, as well as to decrease inflammation. Injections can help reduce swelling from inflamed tissues in the spinal canal, which may result in less irritation on the nerves. The steroid injections are a combination of cortisone (a powerful anti-inflammatory steroid) and a local anesthetic that are given through the back into the epidural space. Epidural steroid injections are not always successful in relieving symptoms of inflammation. They are only used when conservative treatments have failed. Learn more about spinal injections.
Surgery for Lumbar Spinal Stenosis
If nonsurgical treatment does not relieve your symptoms or they worsen over time, and your physician may recommend surgery.
Spinal stenosis may continue to get worse over time. Surgery may be considered as a treatment option if
- you experience an increase in the weakness in your legs
- you can no longer walk without leg pain
- you begin to have trouble controlling your bowels or bladder
- the pain becomes unbearable
Because spinal stenosis is more common in elderly people, one of the considerations for suggesting surgery is the overall physical condition of the patient. Back surgery is a major undertaking. If you have serious medical problems, the risks may be too great to have spine surgery. The decision is jointly made with your surgeon and your regular medical doctor.
The main goal of any surgical procedure used to treat spinal stenosis is to remove the pressure on the nerve roots in the lumbar spinal canal. This means that the tube of the spinal canal must be made larger, and any bone spurs that are pushing into the nerve roots must be removed. This type of surgical procedure is usually called decompression of the lumbar spine, or a decompressive laminectomy of the lumbar spine.
There are several surgical procedures that can be used to treat lumbar spinal stenosis, all of which are designed primarily to relieve any pressure on the spinal cord and nerves.
In order to free up or “decompress” the nerves, the surgeon must remove a section of bone from the back of the spine (lamina). The surgeon may also have to remove a portion of the facet joints. The lamina and facet joints normally provide stability in the spine. Removal of either or both can cause the spine to become loose and unstable. When this occurs, doctors will include fusion as part of the procedure. Likewise, patients with spinal instability who need surgery for spinal stenosis will likely also need lumbar fusion.
If you or a loved one suffers from spinal pain, you owe it to yourself to call Southwest Scoliosis Institute at 214-556-0555 to make an appointment.