Lumbar Spinal Stenosis
With advancing age, the discs between the vertebrae lose their spongy structure and begin to contain less water. This leads to a decrease in disc height and causes the stiffened disc to bulge toward the spinal canal.
The spinal cord carries the nerves that provide sensation and strength to the legs. Due to arthritis (degeneration of the cartilage), the bones and ligaments of the facet joints in the spine thicken and put pressure on the spinal canal. These changes cause narrowing of the lumbar spinal canal, a condition called lumbar spinal stenosis.
Lumbar spinal stenosis can be compared to a garden hose in which lime scale builds up over time. Just as lime narrows the diameter of the hose, spinal stenosis gradually narrows the diameter of the spinal canal.
The lumbar (lower back) spine consists of a series of interconnected bones called vertebrae. These bones surround the spinal canal, which runs between the vertebrae and contains the spinal cord. Other structures that form the boundaries of the spinal canal include the intervertebral discs between the vertebrae, the facet joints, and the ligaments.
What Are the Symptoms of Lumbar Spinal Stenosis?
Lumbar spinal stenosis does not always cause symptoms. However, some people may experience back pain or loss of sensation; pain, cramping, numbness, or weakness in the legs; and complaints such as urinary incontinence.
Symptoms may worsen after prolonged sitting or standing. Existing complaints may come and go and continue over time with varying intensity.
Leaning forward or sitting increases the diameter of the spinal canal and can therefore reduce or even completely relieve pain.
The most typical complaint of patients is the development of weakness, sensory changes, numbness, and tingling in the legs after walking a certain distance, to the point where the legs feel as if they can no longer take another step.
In this situation, patients instinctively look for a place to sit. After sitting and bending slightly forward, strength returns to the legs and they can start walking again. However, after walking another certain distance, the symptoms recur and the need to sit down returns.
How Is Lumbar Spinal Stenosis Diagnosed?
First, you should give your doctor detailed information about your symptoms. X-rays can be taken to look for narrowed disc spaces or thickened facet joints.
Magnetic resonance imaging (MRI) can provide highly detailed information about narrowing within the spinal canal and compression of the spinal cord or nerve roots. Computed tomography (CT) or lumbar myelography can also be used to obtain similarly detailed images.
Each of these studies can provide information about the presence, location, and severity of spinal canal narrowing and nerve root compression.
What Are the Treatment Options for Lumbar Spinal Stenosis?
Once your doctor has diagnosed lumbar spinal stenosis as the cause of your pain, non-surgical treatments will generally be tried first.
Non-Surgical Treatment Methods for Lumbar Spinal Stenosis
Non-surgical treatments for lumbar spinal stenosis include anti-inflammatory medications that reduce inflammation and pain relievers. Physical therapy may also be considered to help maintain and improve flexibility, strength, and overall conditioning, making daily activities easier. Spinal injections (such as epidural corticosteroid injections) may also be recommended.
Medication Treatment in Lumbar Spinal Stenosis
Your doctor may prescribe one or more medications to reduce disease symptoms and complaints and to improve your mobility. Medications used for pain control are called analgesics. In many cases, pain responds to commonly used over-the-counter pain relievers such as aspirin or acetaminophen.
Certain analgesics known as non-steroidal anti-inflammatory drugs (NSAIDs) may be added to help control irritation and inflammation. These include various prescription medications containing active ingredients such as ibuprofen or naproxen.
If your doctor prescribes pain relievers or anti-inflammatory medications, you must be cautious about side effects such as stomach irritation or bleeding. You should be monitored by your doctor for potential problems related to long-term use of prescription or over-the-counter pain relievers and NSAIDs.
If you have severe, persistent pain that does not respond to other analgesics or NSAIDs, your doctor may prescribe narcotic analgesics (such as codeine) for a short period. You must use these medications only in the recommended dose. Taking a higher dose will not speed up your recovery.
High doses of medication can cause nausea, constipation, dizziness, and imbalance, and their use may also lead to dependence. All medications should be taken only as directed. Inform your doctor about all medications you are using (including over-the-counter drugs), and if you have used the recommended painkillers before, explain whether they were effective and what side effects they caused.
Other medications with anti-inflammatory effects are also available. Corticosteroid medications (in tablet or injection form) may occasionally be prescribed for severe low back and leg pain due to their strong anti-inflammatory effects. Like NSAIDs, corticosteroids can have side effects. You should discuss the benefits and risks of these medications with your doctor.
Selective spinal injections or “blocks” can be used to relieve very severe pain. These are corticosteroid injections into the epidural space (the space around the spinal nerves) or into the facet joints, performed by a physician trained in this technique.
Depending on the response to treatment, the first injection can be followed by one or two additional injections at a later time. These are usually administered as part of a comprehensive rehabilitation and treatment program.
Surgery for Lumbar Spinal Stenosis
People with lumbar spinal stenosis often avoid physical activities. This leads to reduced mobility, flexibility, strength, and cardiovascular fitness. Such problems can be improved with a physical therapy or exercise program.
A physical therapy and exercise program usually begins with stretching exercises designed to restore flexibility to tight muscles. You may be asked to repeat these stretching exercises frequently to maintain your flexibility.
Cardiovascular exercises such as using a stationary bicycle, walking on a treadmill, or swimming may be added to the program to improve fitness and increase blood circulation to the nerves. Increased blood flow to the nerves can reduce some symptoms of spinal stenosis. Strengthening exercises for the back, abdominal, and leg muscles may also be prescribed.
If your flexibility, strength, and fitness are maintained and improved, your daily activities will become easier. Your physiotherapist or doctor can explain how to incorporate a regular exercise program into your life using simple equipment at home or by attending a fitness center