Lumbar Stenosis

 

What is it?
Lumbar stenosis is the protrusion of disk, bone spurs, and thickened ligament into the spinal canal in the lower back. Disks are the cartilage between the vertebral bodies that allow for movement of the spine. 

Presentation
The aging process is the most common identifiable cause of lumbar stenosis.  Lumbar stenosis often presents with symptoms of back pain and leg pain.  Most patients with back pain do not have lumbar stenosis, they may have a pulled muscle or joint arthritis.  Lumbar stenosis creates pressure on the nerves in the spine and can cause characteristic pain syndromes.  Pain, numbness, tingling, burning, and weakness often are bundled together and radiate down from the leg, also known as neurogenic claudication.  The leg pain is worse when standing or walking and improve when sitting.  This results in significant reduction in the quality of life as the patient can not walk very far.  Significant spinal canal compromise can result in bowel and bladder incontinence and paralysis (total or partial). 

Examination
Characteristic findings of nerve root compression (causing sensory, reflex and motor changes) are usually not seen. 

Diagnostic Testing
Magnetic resonance imaging (MRI) is the preferred study and should be a high quality lumbar spine study.  The quality of lumbar MRI’s can vary between imaging centers and is usually less sharp with open MRI’s.  Computed tomography (CT) with myelography can be done in special circumstances.  Plain X-rays and bone scans are not useful in diagnosing lumbar stenosis, but may be done as part of the workup of lumbar pain.

Treatment Options
 

Medical Therapy 
Some patients with lumbar stenosis may improve with medical management, typically within the first 6 weeks after the onset of symptoms.

Step 1: Pain relievers, muscle relaxers, and possibly oral steroids (Medrol Dosepak) coupled with bed rest or reduced level of activity. 

Step 2: Physical therapy which includes stretching exercises, heat, massage, and ultrasound. Patients need to determine the modality that works best for them. Each session provides short term benefit and ultimately should also be done at home.

Step 3: Pain management including epidural steroid injections (ESI). ESI is an injection of medication directly into the spinal canal. An ESI typically provides benefit lasting one month and can give lasting relief for those patients who are not surgical candidates.

Surgical Therapy 
Indicated for patients who do not respond to medical management, have severe lumbar stenosis, severe symptoms, are unlikely to respond to further non-surgical treatment, and/or have neurologic loss of function.  An opening in the spine is performed through the back and is called a laminectomy.  Fusion may be required to augment spinal stability as the joints may be so severely degenerated that they are/become incompetent.

Outcome of Surgery
The goal of surgery is to preserve neurologic function, give the best chance for pain reduction and neural recovery, and improve quality of life.  The overall chance of a complication is very small in a healthy patient.  Patients must balance the risk of surgery with quality of life. Surgery is usually very well tolerated.  Most patients are up walking shortly after the surgery and go home the next morning.  Long term outcome from surgery is generally excellent with very high satisfaction rates. 

If you have lumbar stenosis, come see us for consultation.  We take an aggressive approach to the treatment of lumbar stenosis.  We have the clinical experience for great outcomes with a personal touch.