What is lumbar stenosis ?

Lumbar stenosis is a condition of insidious onset characterized by the narrowing of the spinal canal or of the vertebral foramen in the lumbar area. It happens following bony and tissue encroachment of the spinal nerve roots emerging from the narrowed spinal foramen. These exiting nerves are both sensory and motor and innervate the muscles of the buttocks and lower limbs. As this happens, pain and other neurologic symptoms in these areas is experienced.

Causes and risk factors of lumbar stenosisLumbar Stenosis

The cause of lumbar stenosis varies. Predisposing factors may cause the spinal canal to narrow. These factors may come from even the tissues within the spine. Incidence increases with age; the cartilage within the joints degenerate and this leads to osteophyte formed. Other causes are :

  • A condition known as degenerative joint disease or osteoarthritis develops, which may also affect the joints of the lumbar area.
  • Bone conditions, such as Paget’s disease and achondroplasia, may also pose as risk factors.
  • Another cause is spondylolisthesis, a condition marked by the forward slippage of a lumbar vertebra over the other.
  • Abnormal mass growths, such as a spinal tumor.

This condition can happen at any age, but incidence is more common among elderly, osteoarthritis being the most common cause of increased incidence.

Lumbar spinal stenosis symptoms

Lumbar stenosis causes many symptoms depending on the severity of the narrowing of the spinal canal. How worse and for how long these symptoms will last vary from one individual to another. Encroachment of the spinal cord and the nerve roots contribute a crucial part. What follows are some of the common symptoms seen as:

  • Motor – These may include muscle weakness and cramps.
  • Sensory – These includes paresthesias, pain and discomfort in the buttocks and low back area that may go down to the lower limbs and feet. The symptoms are made worse by walking and are relieved by resting for a couple of minutes.
  • Loss of voluntary control – Lumbar stenosis may cause an individual to lose bowel and bladder control, in the worst cases.

These symptoms get aggravated when one bears weight or extends the spine; however, relieved with relaxed sitting or leaning forward.

Diagnosis of lumbar stenosis

A confirmatory diagnosis of lumbar stenosis is made after a series of tests. These tests are necessary to rule out other conditions whose symptoms are similar to lumbar stenosis. A physical examination precedes them. A physical exam includes history and vital signs taking and neurological and musculoskeletal assessments. X-rays are likely to be taken to closely study the changes inside the structures of the spine. Other imaging studies such as a CT scan or MRI of the spine are done as well to aid in the diagnosis of this condition.

Lumbar spinal stenosis treatment

Lumbar stenosis may become chronic if left untreated. As damage to the spinal nerves becomes hard to reverse, the mainstay of lumbar spinal stenosis treatment is to reduce the intensity of the pain or discomfort experienced, and to prevent unlikely complications. Pharmacologic interventions that are used are the following:

  • Nonsteroidal Anti-inflammatory drugs (NSAIDs) – These drugs are the most commonly used for treatment; work to both lessen low back pain and reduce inflammation. Examples are aspirin and ibuprofen, such as Advil.
  • Analgesics – Such as Acetaminophen (Tylenol), also works as a painkiller, but has no action on inflammation.
  • Opiates- These drugs target the low back and relieve pain. Prolonged use is discouraged due to harmful side effects.
  • Corticosteroids- Are used in the form of Epidural Steroid injections (ESIs), lessen swelling inflammation and radiating pain in the lower limbs. Effect is temporary.

Lumbar stenosis exercises

Studies show that lumbar stenosis exercises are useful in alleviating pain symptoms. A referral to physical therapy is done. Physical therapists employ functional retraining exercises used to alleviate pain and swelling. Proper stretches are also taught. Exercises that improve the stability, flexibility, strength and endurance of the muscles of the back, abdomen and legs are also incorporated. Aerobic exercises such as cycling and walking are also included.

Coupled with the use of modalities such as ultrasound, these activities become more effective. Studies show that ultrasound lowers dependence to analgesics for pain relief. Less disability and improvement of symptoms result as a result of this. The use of supportive and assistive devices such as braces and walkers may also be advised to reduce symptoms and to aid in mobility.

Lumbar stenosis surgery

Surgical intervention is advised, when:

  • The aforementioned treatments prove ineffective.
  • Decompression of the spine is warranted due to worsening of symptoms.
  • Disability results- evident by decreased capacity to perform activities of daily living (ADLs).

Prompt consultation greatly increases the options available for a patient. If left untreated, symptoms become severe over time. When patients experience severe pain and discomfort beyond control, they may opt for surgery, such as lumbar laminectomy (that cuts and removes part of a lumbar bone or disc to decompress a nerve root) and spinal fusion (which involves union of lumbar bones to stop movement of a painful one). This option aims to get rid of the connective tissues that encroaches the spinal cord and resume normal activities. It is effective in relieve leg pain but, pain on the back may still linger. Some patients may come back for a second treatment after symptoms of lumbar stenosis recur.

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Filed under: Spinal Stenosis