Lumbar stenosis occurs when there is constriction of available space in the central canal or foraminal vertebra. The portion of spine gets narrowed due to compression causing pain and weakness. The main cause of lumbar stenosis is arthritis. Symptoms of this disorder include low back pain, weakness and reduced sensation in the legs. Lumbar spinal stenosis can be treated with conservative methods of treatment in most of the cases and in rare cases surgery is done for lumbar decompression.
Anatomy :
The lumbar spine consists of 5 sets of tiny bones of vertebral column and is located in the lower back. Nerves that emerge out of the spine travel across the central canal and comes out through the small spaces found on the sides called foramina. These nerve bundles are responsible for carrying signals from the lower end of the body to the brain and vice versa. Any damage or injury to these nerves can affect the movement of legs and toes.
Causes :
As one attains 50 years of age there is 95% chance for the spine to become degenerated due to wear and tear. Congenital lumbar stenosis is very rare in number and such cases are born with deformed spine. Degenerative Disc Disease and degenerative arthritis are the main causes of lumbar spinal stenosis. As one grows old arthritis is the most common problem faced by many people which can damage the cartilages of the joints leading to the formation of bone spurs. This would eventually cause lumbar stenosis as one lumbar disc gets compressed over another causing lack of proper space for the nerves. Conditions like tumor, spine infection and Paget’s disease can also be causative factors for lumbar stenosis.
Who are at risk?
People (both men and women) over 50 years are at risk of developing lumbar stenosis. People with pre-existing arthritis and Osteoporosis are at high risk of developing this problem.
Symptoms :
Some of the common signs of lumbar spinal stenosis are lower back pain, weakness or numbness in the legs. Some people may not have enough sensation in the legs. In many cases the pain gets worse when the person stands or walks for long duration and it improves while sitting or taking rest. Bending the body forward can cause intense pain in your back. Most of the above symptoms get worse over time since degenerative arthritis worsens over time. For some people lumbar stenosis can cause loss of bladder control and even sexual function.
Diagnosis :
Based on your age, health and symptoms your doctor would identify whether you have lumbar stenosis. He would complete his physical examination by asking you to make range of movements to check for pain. Hips and legs area will be examined carefully. He may order for imaging tests like X-rays of spine, pelvic region and hips. If required he may order for further investigations like CT scan or MRI scan or special tests like electromyogram EMG.
Treatment :
For managing mild to moderate pain anti-inflammatory drugs like Ibuprofen can be used. In Chronic Pain condition cortisone pills are recommended. Depending on the severity of the symptoms, your doctor may prescribe Neurontin or Lyrica to control nerve pain. Drugs have to be combined with physiotherapy for getting maximum relief from the symptoms. For severe cases a shot of cortisone injection is given in the lumbar spine.
Surgery is the last option for lumbar spinal stenosis and is considered for those with severe symptoms with loss of bladder/bowel function. Laminectomy or laminotomy or foraminotomy procedure is done for removing compression in the nerve and to create more spaces in the lumbar spine. However surgery carries risk of getting infection in the spine and in some cases the spine can become unstable. Surgery (if successful) can give relief from leg pain and numbness. But there is no guarantee for getting relief from lower back pain. The patient should wear the braces suggested by the doctor until the compression is reduced completely. Nowadays minimally invasive procedure can be done by making tiny incisions which reduces the risk of surgery totally.
Alternative Method :
Acupuncture therapy is useful for reducing the intensity of pain. Similarly chiropractic therapy can be done safely to get rid of pain.
Prognosis :
Prognosis depends on the age and intensity of symptoms of the patient. Some people may show good response after therapy or surgery but others may not.
