Lumbar Spinal Stenosis: Symptoms, Treatment, Outlook
Lumbar spinal stenosis is a narrowing of the canal formed by the bones (vertebrae) of the lower spine. This can put pressure on the spinal cord and nerves that travel through the spinal canal.
In some people, lumbar spinal stenosis doesn’t cause any symptoms. Other people may have pain, tingling, numbness, or muscle weakness in the lower back or legs. Bladder or bowel function can also be affected, but this is more rare.
The most common cause of lumbar spinal stenosis is age-related changes to the spine, such as osteoarthritis or degenerative disc disease. Surgery is generally done only in severe cases. Several nonsurgical treatments are available to reduce pain and other symptoms.
Symptoms of lumbar spinal stenosis depend on the location and severity of the narrowing of the spinal canal. The most common symptoms are:
- Burning pain radiating into the thighs, legs, or buttocks. This can occur on one or both sides of the body. This symptom is sometimes called sciatica.
- Tingling or numbness in the buttocks or legs. Some people have this and the burning pain at the same time.
- Muscle weakness in one or both legs. This can cause a “foot drop,” in which a person can’t keep the toes raised while walking. The calves may also cramp while walking, requiring many short rests.
- Improved symptoms while sitting, leaning forward or lying down. These positions can sometimes create more space for the spinal nerves, which may reduce pain and other symptoms.
- Loss of normal bladder or bowel function. This can happen if the spinal nerves running to the bladder or bowel are compressed. This symptom is more rare.
- Lower back pain. Not everyone with lumbar spinal stenosis has back pain. In general, it depends on how severe the osteoarthritis is.
The most common cause of lumbar spinal stenosis is age-related changes to the discs and vertebrae of the spine. This is also called lumbar spondylosis, osteoarthritis, or degenerative disc disease.
These changes can affect the spinal nerves in several ways:
- Disc degeneration. As the body ages, the discs between the vertebrae dry out and weaken. This causes the discs to collapse and lose some of their height. As a result, there is less space between the vertebrae. This can lead to compression of the spinal nerves as they exit the spinal canal.
- Herniated discs. As the discs weaken, they may bulge into the spinal canal. This can compress the spinal cord or nerves.
- Thickened ligaments. The vertebrae are held together by tough cords. Over time, these can become stiff and thickened. When this happens, they may bulge into the spinal canal.
- Overgrowth of bone. When the cartilage in the joints of the spine wears down, the bones may rub together. This can cause extra growth of the bone, called bone spurs. These can compress the spinal nerves.
Other causes can also lead to lumbar spinal stenosis, such as:
- Congenital problems. Some people are born with spine problems that lead to lumbar spinal stenosis. This is known as congenital spinal stenosis.
- Other spine problems. Curvature of the spine (scoliosis) can cause lumbar spinal stenosis. Osteoarthritis in the joints of the spine can also result in one vertebrae slipping over the other. These shifts in the spine may cause the spinal canal to narrow.
- Tumors. Abnormal growths inside the spinal canal can reduce the space available for the spinal cord and nerves.
- Spinal injuries. Car accidents, surgical injuries and other trauma that affect the vertebrae can reduce the space in the spinal canal. This can happen when pieces of bone are displaced or due to swelling in the spinal canal caused by the injury.
Several factors increase the risk of developing lumbar spinal stenosis, including:
- Older age. Most people with lumbar spinal stenosis are 60 years of age or older.
- Family history of lumbar spinal stenosis or degenerative disc disease.
- Obesity, smoking, and other risk factors for degenerative disc disease.
- Spine problems at birth.
- Scoliosis of the lower back.
- Trauma or surgical injury to the lower back.
A neurosurgeon diagnoses lumbar spinal stenosis based on a person’s medical history, symptoms, physical examination, and test results. This helps them identify the cause of the symptoms and the best treatment.
Medical imaging tests can be used to see what is going on in the lower back. These include:
- X-ray. Focused radiation creates an image of the bony parts of the spine. This will show if there is a narrowing of the spinal canal, a loss of disc height or bone spurs.
- CT scan or CAT scan. Multiple X-rays analyzed with a computer gives a more detailed view of the bony parts of the spine.
- MRI. Powerful magnets and a computer are used to create an image of the soft tissues of the lower back, such as the spinal cord, nerve roots, and discs. It can also show if there is degeneration of the discs or a tumor in the spinal canal.
- Myelogram. A special dye is injected into the space around the spinal cord. This makes the nerves and spinal cord appear on an X-ray or CT scan. This will show if these parts are compressed.
Doctors usually recommend that people first try nonsurgical treatment for lumbar spinal stenosis. These include:
- Physical therapy. A physical therapist guides a person through stretching, strengthening, and aerobic exercises that can be done in the office and at home. The goal of these exercises is to stabilize the muscles of the spine and abdomen. The exercises will also increase the flexibility in the lower back and improve posture.
- Medications. Prescription or over-the-counter drugs may be recommended to reduce pain and inflammation caused by lumbar spinal stenosis. These include aspirin, ibuprofen. naproxen, and prescription opioid pain medications.
- Steroid injections. Cortisone is a medication that reduces inflammation. Injections of cortisone into the “epidural space” around the spinal cord can reduce swelling, pain and other symptoms.
- Chiropractic. Manipulation of the spine by a chiropractor can help reduce pain for some people. However, it can also worsen symptoms or cause injuries in people with disc herniation or osteoporosis.
Surgical treatment is usually used only for people with symptoms severe enough that they greatly affect their quality of life. There are three main types of surgical treatment for lumbar spinal stenosis.
- Laminectomy. This is the most common surgery for lumbar spinal stenosis. A surgeon removes the back part (lamina) of the vertebrae to create more space in the spinal canal. This relieves the pressure on the spinal nerves.
- Spinal fusion. During spinal fusion, a surgeon removes the degenerative disc. A medical device is implanted that keeps the space between the vertebrae and adds stability to the spine. The device is attached to the vertebrae immediately above and below the level of the removed disc. As bone grows around the device, the vertebrae fuse into a single, solid bone.
- Artificial disc replacement. A surgeon removes the degenerative disc and replaces with with an artificial disc. This device is designed to function like a normal disc.
Almost everyone shows signs of age-related changes to the spine by the time they are 60, so you can’t prevent lumbar spinal stenosis. But there are things you can do to help keep your spine healthy, such as:
- Exercise regularly. Exercise strengthens the muscles that stabilize and support the lower back. It also increases the flexibility of the spine. Walking, cycling, swimming, and resistance training are all good choices.
- Keep good posture. Learning how to sit, stand, and move properly can help protect your spine. This includes how to safely lift heavy objects and the best way to support your spine while sitting or sleeping.
- Maintain a healthy weight. Excess weight can make the symptoms of lumbar spinal stenosis worse by putting more stress on the back.
People with lumbar spinal stenosis have many options available to them to help reduce pain and other symptoms of this condition. For best results, learn as much as you can and take an active role in your treatment.
Symptoms of lumbar spinal stenosis vary from mild to more severe. There are several nonsurgical treatments available that can reduce the symptoms of this condition. For more severe cases, surgical treatment can reduce symptoms and restore quality of life.
Because everyone experiences some changes in their spine as they age, lumbar spinal stenosis is a common condition among people who are over 60. To help keep your spine healthy for longer and reduce your risk of lumbar spinal stenosis, exercise regularly, maintain a healthy weight, and practice good posture.
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