Lumbar spinal stenosis is a chronic degenerative condition of the lumbar spine that affects the vertebral bodies and intervertebral discs of the lower back. As the discs lose water content and shrink, spurs often form as osteoarthritis develops. The ligaments can also thicken. This results in narrowing of the spinal canal where the nerves travel.
Lumbar spinal stenosis is quite common, progresses with age and usually affects people over the age of 50.
Many people do not have symptoms, but symptoms can occur at any time. Typical symptoms include:
- Numbness, tingling or weakness of the legs that becomes weaker with walking and improves with sitting or leaning forward (such as while pushing a grocery cart)
- Difficulty with balance or coordination, or bowel and bladder control problems may occur.
- A medical history will be taken and a physical exam will be conducted.
- Imaging can include X-rays, CT scans or MRI of the lower back.
- An EMG (nerve study) may be ordered.
Treatment is aimed at reducing pain and improving function.
Non-surgical treatment may include:
- Physical therapy for strengthening the muscles
- Stationery bike exercises – many patients with spinal stenosis can ride a stationary bike without pain
- Non-steroidal anti-inflammatory medications (NSAIDs)
- Muscle relaxers or medications such as Neurontin or Lyrica
- Steroid injection into the affected area
When symptoms don’t improve with conservative treatment or if there is a progression of neurologic symptoms, surgery may be recommended.
Several types of surgery can be done depending on the severity of the disease, the patient’s age and other medical conditions:
- X-Stop: A device used to decrease the pressure on the nerves. This is an outpatient procedure with a recovery that typically lasts 2-4 weeks.
- Laminectomy: Removal of fragments of bone and soft tissue, which are pushing on the nerves. This involves a 1-3 day hospital stay and may involve bracing. Typical recovery is 6-8 weeks.
- Laminectomy and fusion: For more severe cases, these two procedures may be combined. A fusion is a surgery involving screws and rods being placed and occasionally a bone graft is done. Usual hospital stay is 4 days. Recovery is typically 4-6 months.
These surgeries are often performed from the back.