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Lumbar stenosis is a common condition that results in narrowing of the spinal canal, which in turn causes constriction of the nerve roots. Congenital lumbar stenosis is developmental narrowing of the spinal canal that is not related to aging or degeneration. The more common degenerative lumbar stenosis usually affects older patients and represents a condition that results from various degenerative anatomic landmarks. As the lumbar disc degenerates (wears down), the posterior structures at the same level have to compensate and usually become arthritic (facet arthritis) and/or hypertrophic (enlarged). As the degenerative process continues and the ligaments and the joints enlarge, the space available for the nerve roots that live in the spinal canal becomes less and less, thus turning into lumbar stenosis.
Signs and Symptoms of Lumbar Stenosis
The most common symptom from lumbar stenosis is leg pain. Patients experience what is termed neurogenic claudication, which most typically presents as increased pain in both legs when standing and walking is attempted. This pain is most commonly alleviated by leaning forward (walking with a shopping cart) or sitting. Low back pain may also be associated with stenosis, but is thought to generally derive from associated arthritis and degeneration rather than from the constriction of the nerve roots.
Diagnosis of Lumbar Stenosis
Establishing an accurate lumbar stenosis diagnosis is critical in determining the most appropriate treatment for a patient. Generally, a physician may start the diagnostic process by asking you questions regarding your symptoms and treatments you have tried in the past. He or she may then conduct a full physical examination. Further analysis with x-rays, MRI (magnetic resonance imaging) scans, and, in some cases, a lumbar myelogram may be done to rule out other conditions and establish a definitive lumbar stenosis diagnosis.
Treatment for Spinal Canal Lumbar Stenosis
Treatment of lumbar stenosis generally involves non-surgical modalities. Anti-inflammatory medication, physical therapy and time will usually alleviate some symptoms in the majority of patients. Lumbar epidural steroid injections are often used to try to alleviate pain for those patients who failed to improve with non-invasive treatments. The response to epidural steroid injections is unpredictable, but they may alleviate leg pains for a significant percentage of patients suffering from lumbar stenosis.
Spine surgery for lumbar stenosis is generally reserved for those patients who have failed non-surgical treatments and have severe disabling leg pain when walking (neurogenic claudication). The gold standard spinal surgery treatment currently used for lumbar stenosis is a lumbar laminectomy. A lumbar laminectomy is a surgical procedure that removes the posterior bone in the spinal canal (lamina) and the enlarged ligament (ligamentum flavum) that is commonly associated with it. This, in turn, increases the space available for the nerve roots, which generally helps alleviate the pain in the legs. Alleviation of back pain from a laminectomy is not consistent and generally is not (on its own) a good indication for a laminectomy.
Lumbar stenosis may be associated with other conditions, such as spondylolisthesis (slippage of one vertebra on the other) and/or spondylolysis (a defect in the lumbar vertebrae) that may require different types of operative procedures. As always it is important to seek the advice of a board certified and preferably fellowship trained spine surgeon (orthopedic spine or neurosurgical spine) in order to get all the best options for maximizing a good outcome. We are fortunate to have several excellent spine surgeons in the greater Princeton area and access to a surgeon with these qualifications is recommended. |
