Lumbar Spinal Stenosis
The spine is made of bones called vertebrae. Vertebrae are connected to the disc by faucet (zygapophysial) joints and ligaments. Within the vertebrae is a canal that houses the nerves. In the lumbar or lower spine, these nerves continue into the legs.
With age, the discs that connect and cushion the vertebrae may collapse and ligaments may become calcified. Arthritis may cause bone spurs to form on the joints of the spine. All these changes may cause narrowing in the lumbar spinal also known as spinal stenosis.
Spinal stenosis may, but not always, compress the nerves in the spinal canal. This may cause discomfort in the legs and/or back.
What are the symptoms of spinal stenosis?
Some patients can experience spinal stenosis and never have any symptoms. The stenosis can be revealed through x-rays or other imaging techniques.
If you are suffering from spinal stenosis, you may experience pain, numbness or cramping in the legs. You may or may not have accompanying lower back pain. In rare cases, bowel and/or bladder problems are present.
Your symptoms are often more severe with prolonged standing or walking. Bending forward or sitting may ease the pain - this expands the spinal canal, reducing pressure on nerves.
How is spinal stenosis diagnosed?
Your physician will perform a complete examination including a medical history. Imaging studies (x-rays and/or MRIs) may be needed.
These tools help your doctor determine if you are suffering from spinal stenosis and pinpoint where the problem is located specifically in the lower back area of the spine.
What treatments are available?
In most cases, your doctor will attempt non-surgical procedures to relieve your pain. These treatments may include:
Analgesics such as nonprescription aspirin, ibuprofen, naproxen or acetaminophen often work well in relieving pain. Your doctor may also prescribe nonsteroidal anti-inflammatory drugs, or NSAIDs. Severe pain not relieved by these types of medications may require the use of prescription pain relievers. In most cases, you doctor will only want you to take these medications for a short period.
Your doctor may suggest physical therapy to help relieve the pain, working on flexibility and strength building. In some cases, coping mechanisms such as walkers, canes or other assistive devices may be considered.
The use of spinal injections to ease pain and reduce inflammation may help reduce pain, but do not cure the problem.
Most patients find some relief from the symptoms through combination of nonsurgical treatments. A small percentage, however, do not achieve significant pain relief. If you are suffering from significant and worsening leg weakness or bowel or bladder issues, surgery may be the next step.
What is surgery like?
If you do not respond to nonsurgical options for treating spinal stenosis, your doctor may recommend surgery. The spine surgeons at Marshfield Clinic have years of experience and training in these procedures.
The basic goal of surgery is to open the spinal canal and relieve pressure on the nerves. The surgery is most often a lumbar decompression or laminectomy. You should find substantial improvement in leg pain, although it will not always relieve back pain.
If the vertebrae have become unstable (slipping) because of spinal stenosis, your surgeon may also perform a spinal fusion to stabilize the treated vertebrae.
You can plan on a stay of several days in the hospital following surgery. Your doctor may prescribe a rehabilitation program to return you to activities and normal life. Your recovery period may last from six weeks if your stenosis is very limited, and up to six months if you require a fusion operation.