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LUMBAR SPINAL STENOSIS
At Southwest Scoliosis and Spine Institute, our board-certified, fellowship-trained orthopedic doctors, have treated thousands of patients with complex spine conditions, including Lumbar Spinal Stenosis.
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 Defined
Lumbar spinal stenosis is a medical condition that occurs when there is a narrowing of the spinal canal. When this occurs in the lower back (lumbar region), it puts pressure on the spinal cord and/or nerves. The pressure can cause pain, numbness, and weakness in the legs. At the Southwest Scoliosis and Spine Institute, our orthopedic surgeons, Richard Hostin, MD, Devesh Ramnath, MD, Ishaq 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.
Your spinal cord is a nerve bundle housed in a tunnel—called the spinal canal—formed by your vertebrae. If this canal narrows in the lower back, it’s known as lumbar spinal stenosis. This narrowing leads to pressure on the nerves, which can flare with pain under pressure, such as when coughing.
Causes of Lumbar Spinal Stenosis
Unfortunately, lumbar spinal stenosis or lumbar 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:
- A fall or accident
- 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
- Cauda equina syndrome
While lumbar stenosis is a significant cause of back pain, it’s important to recognize other common sources. According to medical professionals and organizations such as the American Association of Neurological Surgeons, common causes of back pain include:
- Fractures: These can occur from trauma or weakening of the bones.
- Herniated Discs: Discs that bulge or rupture can press on nerves.
- Osteoarthritis: Degenerative joint disease that affects the spine.
- Sciatica: Pain radiating along the sciatic nerve, often due to a herniated disc.
- Scoliosis: Abnormal curvature of the spine.
- Sprains and Strains: Overstretching or tearing of ligaments and muscles.
- Traumatic Injuries: From accidents, falls, or other incidents.
Additionally, while hiatal hernias may contribute to back pain, it’s uncommon for back pain to develop purely due to a hiatal hernia. Larger hiatal hernias could cause back pain, but even that is atypical. Understanding the diverse causes of back pain can help in seeking appropriate treatment and managing symptoms effectively.
Questions and Answers
What are the Symptoms of Lumbar Spinal Stenosis
The most common symptoms of lumbar spinal stenosis include pain or cramping in the legs, numbness or tingling in the legs, weakness in the legs, and difficulty walking or standing for extended periods. Some people may also experience back pain, loss of bladder or bowel control, or sexual dysfunction.
How is Lumbar Spinal Stenosis Diagnosed
Imaging studies used may include the following:
- X-ray: Focuses radiation through the body to create an image and can show the structure of the bones, alignment of the spine, and outline the joints.
- CT scan or CAT scan: Creates images by combining multiple X-rays together and can show the shape and size of the spinal canal, its contents, and the structures around it with details of the bony anatomy.
- MRI: Creates images by using powerful magnets and computer technology and can show the spinal cord, nerve roots, and surrounding areas, as well as enlargement, degeneration, and tumors.
- Myelogram: Injects contrast dye into the spinal fluid space (cerebrospinal fluid) to outline the nerves and spinal cord and show evidence of any pressure affecting these areas, seen on X-ray, sometimes done with a CT scan.
By utilizing a combination of these imaging studies, doctors can obtain a comprehensive view of both the bony and soft tissue structures of the spine. This thorough approach ensures accurate diagnosis and helps in planning the most effective treatment for lumbar spinal stenosis.
What are the non-surgical Treatments for Lumbar Spinal Stenosis
Non-surgical treatments for lumbar spinal stenosis may include physical therapy, exercise, pain management, and the use of assistive devices such as braces or canes. Your doctor may also recommend lifestyle changes such as losing weight, quitting smoking, or modifying your activities to reduce pressure on the spine. In some cases, steroid injections may also be used to reduce inflammation and relieve pain.
Lumbar Spinal Stenosis
“Lumbar Spinal stenosis is a condition where the nerves in the lower back are being compressed. Some treatments include medication, physical therapy, and epidural steroid injections. If patients do not respond to conservative treatments, surgery can help to open up the space available for the nerves.” –
Dr. Devesh Ramnath
What are the Connections of the Lumbar Spine With Other Parts of the Spine?
The lumbar spine, or lower back, plays a crucial role in the spinal structure by connecting to other key parts of the spine. Specifically, it links to the thoracic spine at the upper end through what is known as the thoracolumbar junction. This joint is critical for providing mobility and stability between the upper and middle sections of the back. Additionally, at its lower end, the lumbar spine connects to the sacral spine through the lumbosacrl joint. This joint is vital for supporting weight and enabling movement between the lower back and the pelvis. Together, these connections allow for a wide range of flexibility and support throughout the spinal column.
How Can the Lumbar Motion Segments Be Affected By Different Disorders?
Lumbar motion segments, fundamental in enabling movement and stability to the spine, can become compromised by various types of disorders. These disorders are broadly categorized as follows:
- Congenital Disorders: These are conditions that are present from birth, affecting the structural integrity and function of the lumbar segments.
- Degenerative Disorders: Over time, wear and tear on the spine can lead to degenerative conditions that impair the lumbar segments’ functionality.
- Traumatic Disorders: Injuries from accidents or falls can cause immediate and severe impact on the lumbar regions.
- Inflammatory Disorders: These involve the swelling and irritation of lumbar tissues, which can destabilize this crucial part of the spine.
How are the Structures in a Motion Segment Held Together?
The components of a motion segment are meticulously interconnected by several vital elements. Ligaments, muscles, and tendons form a cohesive network, ensuring stability and flexibility. This arrangement allows for smooth movement and robust support within the segment, essential for the body’s mobility and functionality.
Understanding the Components of a Lumbar Spinal Motion Segment
A lumbar spinal motion segment is a key structural unit of the lower back, crucial for supporting the upper body and enabling movement. Here’s an in-depth look at what this motion segment consists of:
Vertebrae
The segment includes two consecutive bones called vertebrae (e.g., L4 and L5) which are aligned vertically. These bones form the backbone, providing structural stability and support.
Intervertebral Disc
Situated between the vertebrae is an intervertebral disc. This component is crucial as it helps in absorbing shocks and maintaining flexibility. It features a gel-like center encased in a tough exterior, aiding in comfortable movement and cushioning the vertebrae during various activities.
Facet Joints
Each motion segment contains two facet joints, located on either side of the vertebrae. These joints are pivotal in facilitating bending and twisting actions of the lower back, allowing for smooth and flexible movement.
Spinal Nerves
The segment also houses two spinal nerves that emerge from the spinal cord. These nerves pass through openings between the vertebrae and extend into the lower body, playing vital roles in motor and sensory functions in the pelvis and legs.
In essence, a lumbar spinal motion segment is made up of a sophisticated arrangement of vertebrae, an intervertebral disc, facet joints, and spinal nerves, each contributing to the segment’s functionality and resilience. This design not only supports bodily movements but also protects critical elements of the nervous system.
How Does the Lordotic Curve in the Lumbar Spine Contribute To Lower Back Pain?
The lumbar spine, or lower back, is naturally shaped with a slight inward curve known as lordosis. This curvature plays a crucial role in how our bodies distribute weight and manage stress across the spinal column. Properly aligned, the lordotic curve helps in maintaining balance and absorbing shock, thereby protecting the spine during daily activities.
However, deviations from the normal curvature can lead to issues. When the curve is too pronounced (hyperlordosis) or insufficiently curved (hypo-lordosis), it can disrupt this balance. Such alterations not only increase the strain on the spine but also lead to concentrated stress in the lower back. Over time, this undue stress can cause discomfort, pain, or more serious back conditions.
Understanding the significance of the lumbar spine’s lordotic curve is essential in identifying and treating lower back pain. Regular check-ups with a healthcare professional can help monitor spinal health and prevent potential complications associated with changes in this curve.
Understanding Lumbar Spine Protection
The lumbar spine plays a crucial role in safeguarding certain critical components of the nervous system. Its architecture is specially designed to offer maximum protection while facilitating bodily movements.
Key Protective Structures
- The upper segment of the lumbar spine includes vertebrae that are primarily responsible for encasing the spinal cord. This area contains the vertebral arches, a series of bone structures that form a protective tunnel for the spinal cord, shielding it from external shocks and injuries.
- As the spinal cord tapers down toward the lower end of the spine, it transitions into a bundle of nerve fibers known as the cauda equina. These nerves extend downwards from the spinal cord. The lower lumbers provide a robust bony framework that acts as a protective enclosure for these nerve fibers, ensuring they are not compressed or damaged.
Significance of Lumbar Protection
This protective arrangement allows the lumbar spine to fulfill dual functions: ensuring the safe transmission of neural signals across the body and supporting flexible movement. This balance is vital for maintaining overall spinal health and functionality, highlighting the lumbar spine’s critical role in the body’s nervous system infrastructure.
What are the primary movements facilitated by the lower back?
The lower back, primarily through the lumbar region, facilitates a range of essential movements for the trunk of the body. Here are the primary movements supported by the lower back:
- Flexion and Extension: This includes bending forward and arching backward, movements that primarily involve the trunk flexing and extending from the lower back.
- Lateral Flexion: The lower back enables side-to-side movements, which involve bending the trunk to either side.
- Rotation: The lower back also supports the twisting of the torso. This movement typically occurs at the last two levels of the lumbar vertebrae, allowing the trunk to rotate left or right.
The lower back plays a crucial role in the human body, performing several essential functions:
- Support and Stabilization: It serves as a foundational support for the upper body, helping to keep the torso stable and upright. This functionality is key to maintaining balance and posture.
- Movement: The lower back allows for a range of movements of the trunk, from twisting to bending, which is essential for daily activities and flexibility.
- Protection: It safeguards vital anatomical components such as the spinal cord and the cauda equina, which are critical networks of nerve fibers that extend from the lower spine.
- Leg Control: Additionally, the lower back is instrumental in facilitating the control and movement of the legs, enabling walking, running, and other activities.
Overall, the lower back’s ability to perform these functions is vital not only for movement but also for overall structural integrity and protection within the body.
These movements underscore the importance of the lower back in providing both mobility and support to the upper body, enabling a wide range of activities from daily tasks to complex exercises.
The lower back plays a crucial role in the human body, performing several essential functions:
- Support and Stabilization: It serves as a foundational support for the upper body, helping to keep the torso stable and upright. This functionality is key to maintaining balance and posture.
- Movement: The lower back allows for a range of movements of the trunk, from twisting to bending. This is essential for daily activities and flexibility.
- Protection: It safeguards vital anatomical components such as the spinal cord and the cauda equina. These are critical networks of nerve fibers that extend from the lower spine.
- Leg Control: Additionally, the lower back is instrumental in facilitating the control and movement of the legs. For instance it enables walking, running, and other activities.
Overall, the lower back’s ability to perform these functions is vital not only for movement but also for overall structural integrity and protection within the body.
How do nerve roots branch out from the spinal cord in the lumbar spine?
In the lumbar region of the spine, nerve roots make their departure from the spinal cord with a critical function. These nerves extend from the lower back area, traversing along the posterior part of each leg. They continue their path all the way down, reaching the toes. This branching pattern is essential for transmitting signals that control muscle movements and convey sensory information from the legs to the brain.
What is the lumbar spine composed of?
The lumbar spine, which is a crucial segment of the lower back, is composed of several essential components. These include:
- Vertebral Bones: These are the series of small bones that stack together to form the spine.
- Intervertebral Discs: Situated between the vertebral bones, these discs act as cushioning pads and help in movement and flexibility.
- Nerves: These are responsible for transmitting signals between the brain and the body.
- Muscles: Muscles support and facilitate movement of the spine.
- Ligaments: These are tough bands that connect bones and stabilize the spine.
- Blood Vessels: These supply the spine with necessary nutrients and oxygen.
Each of these elements plays a vital role in the structure and function of the lumbar spine.
Lumbar Spinal Stenosis Symptoms
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)
- Burning pain
- Cramping, Numbness or tingling sensation in the legs and/or feet
- Muscle weakness in the legs and/or feet
- Narrowing of the spinal canal
- Loss of bladder or bowel control
“You’ll likely notice that pain worsens with sudden movements of your back or when coughing,” says Dr. Weisman of our staff. “You may also have pain in the upper back that could be dull or throbbing.”
Additionally, pain can intensify with activities that involve bending backward or prolonged standing. Symptoms often improve when bending forward or sitting down. Understanding these specific triggers can help you manage daily activities more effectively.
Treatment options typically depend on the severity of your condition. Most often, doctors first recommend medication and physical therapy. However, if your quality of life is significantly affected, surgical options might be considered.
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. In addition, the doctor will check for sensation loss, or muscle weakness resulting from a disc compressing the spinal cord.
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. Treatment will depend on the severity of your stenosis.
In addition to managing pain with non-steroidal anti-inflammatory drugs (NSAIDs), your doctor may recommend physical therapy and/or exercises designed to strengthen the muscles in the back and stabilize the spine. Most likely, your doctor will first recommend medication and physical therapy.
Furthermore, your doctor may also discuss using epidural steroid injections to decrease swelling in and around any affected nerves. However, if your quality of life is significantly affected, surgery may be needed.
On your first visit to a back specialist, the initial diagnosis will disclose the seriousness of the problem. After the exam, your doctor will develop a specific treatment plan 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 as 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.
Medications
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.
Learn more about medications used to treat back pain.
Physical Therapy
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 them 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
Learn more about spinal rehabilitation.
Epidural Steroid Injection
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, 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
A patient may also be considered a candidate for surgery if:
- Back and leg pain limits normal activity or impairs quality of life
- Progressive neurological deficits develop (leg weakness, foot drop, numbness in the limb)
- Medications and physical therapy are not effective
- The patient is in reasonably good health
Because lumbar stenosis occurs more commonly in older people, the patient’s physical condition plays an important part in possible surgery. Your spine surgeon and your regular medical doctor will jointly make the surgery decision.
There are several different surgical procedures that can be utilized, and the choice of which is influenced by the severity of the case. For instance, in a small percentage of patients, spinal instability may require that spinal fusion be performed — this decision generally is determined prior to surgery. Spinal fusion is an operation that creates a solid union between two or more vertebrae. It can assist in strengthening and stabilizing the spine, thus helping to alleviate severe and chronic back pain.
Stopping the Pain
Therefore, the main goal 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 become larger. Additionally, any bone spurs that push into the nerve roots need to be removed. Doctors refer to this type of surgical procedure as a decompression of the lumbar spine or a decompressive laminectomy of the lumbar spine.
The surgical treatment is fairly straightforward. 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.
Criteria for Surgery in Lumbar Spinal Stenosis Patients
Determining whether a patient with lumbar spinal stenosis is a suitable candidate for surgery involves evaluating several key factors:
- Significant Pain Impact: Patients whose back and leg pain severely restricts daily activities or detracts from their quality of life may need surgical intervention.
- Neurological Symptoms: Worsening neurological issues such as leg weakness, foot drop, or numbness indicate the need for a more aggressive treatment like surgery.
- Bowel/Bladder Dysfunction: The onset of abnormal bowel or bladder functions can signal severe spinal pressure, necessitating surgical relief.
- Mobility Challenges: If standing or walking becomes increasingly difficult, surgery might be the next step after conservative treatments fail.
- Ineffective Non-Surgical Treatments: When medications and physical therapy do not provide adequate relief, surgery becomes a viable option.
- Overall Health Status: Patients should be in good overall health to withstand the surgical procedure and recovery process effectively.
Evaluating these criteria ensures that only those who will potentially benefit most from the procedure are selected for surgery.
Common Types of Surgeries for Treating Lumbar Spinal Stenosis
When dealing with lumbar spinal stenosis, several surgical options are available to relieve pressure on the spinal cord and nerve roots. Here are some of the most common types:
1. Laminotomy
This procedure involves creating an opening in the lamina, a part of the vertebral bone, to alleviate pressure on the nerve roots. Unlike a full laminectomy, only a portion of the lamina is removed.
Learn more about lumbar laminectomy.
2. Foraminotomy
In a foraminotomy, surgeons enlarge the bony exit where the nerve roots leave the spinal canal. This can be performed in conjunction with other procedures like a laminotomy or laminectomy.
3. Medial Facetectomy
This technique focuses on removing part of the facet joint, which may be overgrown, to provide more space within the spinal canal, reducing nerve compression.
4. Anterior Lumbar Interbody Fusion (ALIF)
ALIF involves removing a degenerative disk through an incision in the lower abdomen. A structural device made from materials such as bone, metal, or carbon fiber is placed in the space previously occupied by the disk. This device is packed with bone graft material to promote fusion between the vertebrae above and below the removed disk.
5. Posterior Lumbar Interbody Fusion (PLIF)
In PLIF, surgeons access the spine through an incision in the back. The procedure involves removing the degenerative disk and the posterior bone of the spinal canal. A structural device is then inserted and packed with bone graft material to promote vertebral fusion. This method typically treats both sides of the spine.
6. Transforaminal Lumbar Interbody Fusion (TLIF)
Similar to PLIF, TLIF is performed through an incision in the back. However, it usually focuses on only one side of the spine. The degenerative disk is removed, and a structural device is inserted and filled with bone graft to encourage fusion between vertebrae.
7. Posterolateral Fusion
In this procedure, bone graft material is placed on the back and sides of the spine to achieve fusion. This method might be used in conjunction with other surgical techniques for added stability.
8. Instrumented Fusion
This type of fusion involves using hardware like hooks, screws, and other devices to provide additional stability and support during the fusion process. Each surgery has specific indications and complexities, so a thorough consultation with a healthcare provider is essential to determine the most suitable approach.
Learn more about lumbar spine fusion.
Recovery From Lumbar Spinal Stenosis Surgery
The recovery from an operation for lumbar spinal stenosis can vary depending on the type and extent of the surgery. Of course, the individual patient’s health and other factors will affect recovery. In general, most patients can expect to stay in the hospital for a few days following the surgery. They can then gradually resume their normal activities over a period of weeks to months.
Immediately after surgery, patients may experience some pain and discomfort, which the doctors and nurses will manage with pain medication. The doctors may also instruct the patient to wear a back brace or limit certain activities. For example, patients should avoid bending or twisting, to help the healing process. Your doctors may also recommend Physical therapy to help regain strength and mobility.
It is important for patients to follow their surgeon’s instructions for post-operative care and rehabilitation. These instructions may include exercises to strengthen the back and core muscles. Walking or other low-impact activities may be recommended while discouraging high-impact activities like running or jumping. It may take several months to fully recover from the surgery and return to normal activities. Some patients may need ongoing follow-up care with their surgeon or their regular doctor to monitor their progress.
Why Choose the Southwest Scoliosis and Spine Institute
Finally, there are many reasons why you should choose the Southwest Scoliosis and Spine Institute to treat your lumbar spinal scoliosis. Here are a few:
- They have a team of experienced and board-certified surgeons who specialize in treating spinal conditions, including scoliosis.
- They offer a variety of treatment options, including non-surgical and surgical treatments.
- They have a state-of-the-art facility that is equipped with the latest technology for diagnosing and treating spinal conditions.
- They have a reputation throughout the Nation for providing the very best spinal care for their patients.
- They are conveniently located in three locations in Dallas, Plano, and Frisco, Texas.
If you are considering treatment for lumbar spinal scoliosis, we encourage you to schedule a consultation with the Southwest Scoliosis and Spine Institute. Basically, they can help you to understand your condition and develop a treatment plan that is right for you.
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American Association of Neurological Surgeons: Lumbar Spinal Stenosis
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.