Lumbar Spinal Stenosis
Lumbar spinal stenosis is a common degenerative disorder. The hallmark symptom is neurogenic claudication, a condition that causes leg pain, weakness and heaviness when walking and standing. Degenerative changes are seen in almost 95% of people by age 50. Lumbar spinal stenosis is often found in people over age 60 and destroys quality of life, affecting personal, social and occupational choices. It is a significant cause of disability in older individuals, and the most important indication for spinal surgery among people older than age 65.
Lumbar spinal stenosis is the narrowing of the spinal canal that puts pressure on the spinal cord and nerves. The canal can be narrowed by constrictions that occur in different sections due to different mechanisms all at once. Aging, chronic wear and tear, and trauma are the most significant risk factors.
- Herniated Discs: When the soft material inside a disc pushes out through a crack in the tough exterior, it can press on the nerves.
- Degenerative Disease: As discs and facet joints age, they lose hydration and elasticity, surrounding ligaments may thicken, and bone spurs can develop, which can result in the narrowing of the spinal canal.
- Spondylolisthesis: A condition where one vertebra slips forward over the one below it, potentially compressing the spinal cord or nerves.
- Scoliosis: A tilting of the spine on the frontal view, adult deformity can lead to narrowing of the spinal canal.
- Trauma: Fractures may occur causing bone fragments or resulting instability to narrow the spinal canal.
- Tumors or Infections: In some cases, abnormal tumors or infections may compress the spinal nerves.
- Congenital Conditions: Some individuals are born with a naturally narrow spinal canal.
The symptoms of lumbar spinal stenosis can vary depending on the severity of the condition and the specific nerves that are affected. Some common symptoms include:
- Pain radiating down the leg (Sciatica)
- Numbness and tingling sensations or a pins and needles feeling in the legs, feet or buttocks.
- Foot drop, difficulty lifting the front part of the foot due to weakness which can contribute to balance problems and increase fall risks.
- Muscle weakness in the legs or feet, which can lead to difficulty walking or standing for long periods.
- Leg cramps, especially after walking or standing for long periods, and can be relieved with sitting.
- Difficulty with balance leading to an increased risk of falls.
- Loss of bladder or bowel control (in severe cases).
- Some forms of chronic back pain
Diagnosis involves a review of your medical history, inquiry about your symptoms, clinical examination, and imaging studies. Dr. Colman will discuss your symptoms and your medical history. He may ask you to perform certain movements to look for limitations and pain.
He may order imaging studies including:
- X-rays to visualize the bony structure of the spine. X-rays can help identify age-related degeneration that could cause narrowing of the canal, including instability, deformity, disc height loss, or bone spurs.
- An MRI can provide detailed images of the soft tissues, including the ligaments and the discs.
- A CT scan can provide detailed images of the bones of the spine. Sometimes it may be combined with a myelography, a dye injection to better visualize the spinal canal.
With all of this information, Dr. Colman will make his diagnosis, answer your questions, and discuss your treatment options so you can make an informed choice about your care.
Conservative Treatments
The goal is to relieve pain and restore function. This includes pain relievers and anti-inflammatory drugs plus muscle relaxants, if needed, to manage symptoms. Additionally, physical therapy to strengthen the back and abdominal muscles, improve flexibility and to enhance overall function, and/or epidural steroid injections to reduce inflammation and pain. Acupuncture and chiropractic may help with pain and function.
Surgical intervention
Surgical intervention is reserved for people with lumbar spinal stenosis who have poor quality of life and difficulty walking or standing for extended periods.
- Laminectomy is decompression surgery that involves the removal of part of the lamina, the bone covering the spinal canal, bone spurs and hardened ligaments that are compressing the spine and nerves.
- Foraminotomy is designed to enlarge the openings where the nerve roots exit the spinal canal to relieve pain and compression.
- Spinal fusion is an option when arthritis has progressed to spinal instability. It involves joining two or more vertebrae to stabilize the spine.
Recovery involves moderate activity, avoiding heavy lifting, awkward twisting and leaning and avoiding sitting for prolonged periods. Rehabilitation is essential to recovery from lumbar spine surgery for spinal stenosis. Rehabilitation involves multiple different modalities including physical therapy to restore strength and function and relieve pain, mobilization techniques, and the use of assistive devices like walking aids. Rehabilitation helps to improve clinical outcomes
When you or a loved one has lower back and leg pain, it is important to see an expert. Contact Dr. Matthew Colman at Northwestern Medicine in Chicago, Illinois. He specializes in degenerative spine conditions, spine trauma, spinal deformities, and spine oncology. His patients find him to be a kind, caring, and thorough surgeon, who has a wonderful bedside manner, and is knowledgeable and trustworthy. They note that he takes time to listen to his patients, explains conditions well and answers their questions. Contact him at Northwestern Medicine in Chicago, Illinois to schedule a consultation to receive the correct diagnosis and all your treatment options today.
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Dr. Matthew Colman
- Internationally recognized expertise and thought leadership for a diverse range of spinal problems
- Patient-specific and humanistic approach which uses the latest technology and techniques
- Team centered approach prioritizes availability, communication, and support
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