Lumbar spinal stenosis is a condition that results from a narrowing of space in the spinal canal. Here you will find information about the condition including how it is diagnosed and different treatment options.

The normal spine nerves in the lumbar spine are encased in a fluid sac called dura . The lumbar vertebrae protect this fluid sac also called thecal sac. In conditions of advanced wear and tear, there is the narrowing of this space over time. This results in pressure onto the spinal nerves. This condition usually affects patients who are in the fifth or sixth decade or older. 

Symptoms 

The usual symptoms of this condition are low back pain with pain in the legs that worsens when walking. There may also be sensory problems including numbness or pins and needles. This can result in progressive difficulty with walking. At times, symptoms are more pronounced when standing straight or lying-in bed at night.

Causes

The narrowing of the spinal canal space is usually a result of many factors. These include:

  • disc prolapses
  • thickening of the ligament supporting the spinal vertebrae
  • arthritis
  • hypertrophy of the joints of the spine
  • loss of disc height
  • the formation of bony spurs
  • congenital narrow spinal canal

Risk Factors

Ageing is the major factor responsible for lumbar spinal stenosis as the disease is related to the disintegration of the spine. Another associated factor is osteoporosis as it causes firmness. This results in fracture of the lumbar vertebrae leading to lumbar spinal stenosis. Some other related factors are trauma, scoliosis and genetic diseases disturbing the muscle and bone expansion all over the body. These risk factors can be identified and diagnosed with spinal imaging.

Complications

Different complications observed in patients are: –

  • The patients have reported intractable back or radicular pain.
  • The disease can lead to numbness and lower extremity weakness.
  • Incontinence in patient and balance problems.
  • Sometimes the disease can lead to paralysis.
  • While uncommon, cauda equina syndrome is noticed in some patients. The nerves present below the spine get damaged with this condition.

Lumbar Spinal Stenosis Diagnosis

Before the diagnosis, a detailed medical history of the patient is required. A person without blood vessel narrowing who also experiences a history of pain in the back and legs which gets worse on walking, standing straight or lying down flat in bed suggests a possible spinal cause. An MRI scan can diagnose this condition. CT scans and static and dynamic x-rays of the lumbar spine may also be conducted. The information from these additional tests contributes to the creation of a treatment plan. Occasionally, we may conduct a distinct nerve test with electromyogram. This test finds the injury or irritation in the nerves due to enduring compression by lumbar spinal stenosis. 

Lumbar Spinal Stenosis Treatment

In conditions where the symptoms are mild, non-operative treatment is an option. This is usually when the spinal canal or nerve root is not significant compromised. 

Non-surgical treatments can be quite effective and can include:

  • pain relief medication
  • non-steroidal anti-inflammatory drugs
  • physiotherapy
  • hydrotherapy
  • swimming
  • pilates

In a small subset of patients, there might be the option for CT guided injections into the spine. However, this is not usually recommended in the presence of moderate to severe spinal canal stenosis.

In conditions where the symptoms of spinal canal stenosis are moderate to severe, treatment will differ. The definitive treatment for this condition is to perform a surgical treatment such as laminectomy and rhizolysis. This involves making an incision in the back to expose the most affected spinal segment. A channel of bone in the spine and the abnormally thickened ligaments are removed. This makes more space for the spinal nerves. Patients find this surgery to be very effective in relieving pain and increasing mobility. This type of surgical treatment is performed using microsurgical and keyhole surgery techniques to help the patient recover quicker.

In patients who have spinal instability, a minimally invasive fusion may be added on to the laminectomy to avoid medium to long term post laminectomy instability.

Prevention

Most individuals above the age of 50 years have some sort of osteoarthritis. In such cases, the chances of preventing lumbar spinal stenosis are minimal. However, the patient can decrease the chances of getting stenosis. The ways by which the patient can reduce the chances include: 

  • Exercise: Daily exercise is necessary to improve muscle strength, which will make the spine flexible. Walking, cycling, weight training, swimming, and aerobic exercise help maintain a healthy back.
  • Posture: A good posture can prevent the patient from many ailments. The patient should lift objects by bending at the knees instead of bending at the back. A firm mattress should be used to sleep as it maintains the natural curves of the body.
  • Bodyweight: Surplus weight can put a strain on the back of the body and lead to lumbar spinal stenosis.

Clinical Trials or Research

There are multiple ongoing research studies to study the disease as well as its potential treatment options. There is an ongoing clinical trial to treat chronic pain associated with lumbar spinal stenosis that involves direct current stimulation. The objective of this study to check how effective tDCS is in controlling pain due to lumbar spinal stenois. Another clinical trial in 2019, compared the results of neuroplasty among patients with sarcopenia and without sarcopenia. The method involved the use of several tools such as numeric rating scale and Oswestry disability index. 

Frequently asked patient questions

How is spinal stenosis diagnosed?

Spinal stenosis is diagnosed by surgeons putting together the information obtained from clinical history, examination and results of radiological tests such as MRI and dynamic X -rays.

Are there treatment options that do not involve surgery?

Yes, various non-invasive methods are trialled for spinal stenosis treatment. These are corticosteroid injections, physical therapy, NSAIDs like ibuprofen and aspirin, rest, anaesthetic injections, hydrotherapy and use of supportive braces.

What are the risks to consider with surgery?

The general risks related to spinal stenosis surgery are blood clots, infection, a tear in the spinal sac covering the spinal cord, chronic pain, numbness or weakness and a possibility of developing post laminectomy instability.

How soon after surgery can one return to simple activities like walking and gentle exercise? 

Patients undergoing minimally invasive laminectomy are encouraged and assisted to walk the same days as surgery. They are provided with an exercise plan by the physiotherapist. 

Can injections relieve spinal stenosis?

No, an injection may provide temporary relief of symptoms but it does not address the cause factors which relate to the narrowing of the spinal canal resulting in pressure on spinal nerves.