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
At the Southwest Scoliosis and Spine Institute, our orthopedic surgeons, Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Y. Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, are all board-certified, fellowship-trained surgeons with years of experience treating patients with complex spine conditions – including lumbar spinal stenosis.
Unfortunately, lumbar spinal stenosis primarily affects adults (50 years old and older). Similarly, this condition results from normal age-related causes like wear and tear, arthritis, or both. Other conditions that can lead to this 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
When lumbar spinal stenosis occurs, the patient may or may not have symptoms. However, 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 of lumbar spinal stenosis decrease when sitting or leaning forward, and get worse when standing up straight and walking. In severe cases, this condition can lead to a loss of bladder or bowel control. While rare, it can indicate a serious condition that requires immediate medical attention.
Diagnosis and Testing
To fully understand your condition, the doctor will look carefully at your medical history before performing a thorough physical exam. During the exam, the doctor will look for any signs of limited mobility and/or pain in the lumbar spine. In addition, the doctor will also look for any problems with balancing, as well as any reductions in muscle reflexes, loss of sensation, or muscle weakness that results from the spinal cord being compressed by a disc.
If the doctor suspects you have lumbar spinal stenosis, the doctor will confirm this through X-ray imaging, CT scans, or MRI scans. Although X-rays can show issues with the bones of the spine, such as bone spurs, loss of bone height, or spondylolisthesis, CT and MRI scans are usually needed to determine problems with the soft tissue of the spinal cord and surrounding nerves.
In Addition, our practice uses an advanced digital low-dose X-ray imaging system that takes high-quality images in just seconds. Also, this system can also capture X-rays of patients while in a standing or seated position, and it’s located inside our Dallas location, meaning you and your doctor can review the X-rays quickly.
Treatment for Lumbar Spinal Stenosis
Fortunately, not all patients with this condition will require surgery, and often their condition can improve with the help of treatments. In addition to managing pain with non-steroidal anti-inflammatory drugs (NSAIDs), your doctor at Southwest Scoliosis and Spine Institute may recommend physical therapy and/or exercises designed to strengthen the muscles in the back and stabilize the spine. Furthermore, your doctor 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 diagnosis will disclose the seriousness of the problem. After the exam, treatment will be considered and in some cases, it might involve surgery. Fortunately, the vast majority of back problems do not require surgery. To clarify, our doctors consider Spinal stenosis is a slowly progressive back problem that may respond to excellent care.
With today’s advanced treatments, a variety of options exist for spinal stenosis. In most cases, simple therapies such as mild pain medicine and rest relieve the pain. If symptoms are not relieved with simple measures, physical therapy also works. Moreover, 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.
When taken properly, mild pain medication can reduce pain. However, the medicines will not cure or stop the progression of the problem, but they will help with pain control.
If your condition causes only mild symptoms and does not appear to get worse, your doctor may have you work with a physical therapist. Upon a patient entering a well-rounded rehab program, doctors see that it assists in calming pain. Also, it will improve the patient’s mobility and strength to help conduct daily activities with greater ease and ability.
To reduce pain, positions, movements, and exercises are prescribed. In addition, treatments may also include lumbar traction to gently stretch the low back, easing pressure on the spinal nerves. To tone the low back and stomach muscles, exercises are used to improve fitness. As a result, the doctor may schedule therapy sessions 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) will relieve the pain of stenosis and irritated nerve roots. Injections can help reduce swelling from inflamed tissues in the spinal canal, which may result in less irritation on the nerves. As you are aware, the steroid injections contain cortisone and are given through the back into the epidural space. Sometimes, these injections are not successful in relieving symptoms, and they are only used when normal treatments have failed.
Surgery for Lumbar Spinal Stenosis
If normal treatment does not relieve a patient’s symptoms over time, the following conditions could cause surgery:
- An increase in leg weakness
- Walking with leg pain
- Trouble controlling your bowels or bladder
- Pain becomes unbearable
Because spinal stenosis occurs more commonly in elderly people, the patient’s physical condition plays an important part in possible surgery. If the surgery will proceed, the surgeon and the patient’s regular medical doctor will jointly make the decision.
Therefore, the main goal to treat spinal stenosis is to remove the pressure on the nerve roots in the lumbar spinal canal. For instance, this means that the tube of the spinal canal must become larger, and any bone spurs removed that push into the nerve roots. For instance, doctors refer to this type of surgical procedure as decompression of the lumbar spine or a decompressive laminectomy of the lumbar spine.
In order to free up or “decompress” the nerves, the surgeon must remove a section of bone from the back of the spine (lamina). Then, the surgeon may also have to remove a portion of the facet joints, which provide stability to the spine. Upon removal of either or both, the spine can 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 and Spine Institute at 214-556-0555 to make an appointment.