Understanding Lumbar Spinal Stenosis: Causes, Symptoms, and Treatments

• What Is Lumbar Spinal Stenosis?
• What Are The Symptoms Of Lumbar Spinal Stenosis?
• What Causes Lumbar Spinal Stenosis?
• How Is Lumbar Spinal Stenosis Diagnosed?
• What Are The Treatments For Lumbar Spinal Stenosis?

Are you struggling with persistent back pain? About 70% to 85% of adults experience back pain at some point. Identifying the root cause of the pain is not always straightforward. 

Back pain can often radiate from the back into the buttocks and lower extremities, making it challenging to diagnose, but it could be a sign of lumbar spinal stenosis.

At Coastal Orthopedics, we know how challenging it can be to deal with back pain and related conditions. In this post, learn the complexities of lumbar spinal stenosis, including its causes, symptoms, diagnostic methods, and treatment options.

The lumbar spine, located in the lower back, consists of five vertebrae situated between the ribs and the pelvis. Lumbar spinal stenosis occurs when the spinal canal narrows, putting pressure on the nerves that extend from the lower back into the legs. While it can affect younger individuals due to developmental factors, it mainly affects individuals aged 60 and above as a degenerative condition.

The spinal canal constriction typically occurs gradually over many years or even decades. As people age, the intervertebral discs lose their sponginess, reducing disc height and potentially bulging the hardened disc material into the spinal canal. 

The formation of bone spurs and the thickening of ligaments may further contribute to the narrowing of the central canal, leading to potential symptoms. These symptoms may arise from inflammation, nerve compression, or both factors.

Back pain in spinal stenosis varies based on the degree of arthritis present. The condition can cause sciatica, characterized by buttocks pain radiating down the leg. This discomfort can be described as an ache or burning sensation, often starting in the buttocks and extending to the foot. Numbness and tingling may also occur, typically accompanying the burning pain. As the condition progresses, weakness in the legs can develop, sometimes leading to a foot drop, making it challenging to lift the front part of the foot while walking.

In severe cases, acute cauda equina syndrome may occur, requiring immediate medical attention. This condition involves numbness in the genital area, loss of bowel or bladder control, and leg weakness, which can result in an inability to walk.

People with spinal stenosis often find relief when leaning forward, as this position can increase the space for the nerves. Conversely, standing upright and walking tend to worsen the pain. Some individuals can tolerate activities like riding a stationary bike or walking with the support of a shopping cart, but more extended periods of walking may exacerbate the symptoms.

Arthritis, a common cause of spinal stenosis, involves joint degeneration. In the spine, it occurs as the intervertebral discs lose water content over time. This natural aging process leads to disc settling and decreased disc space height.

As discs lose height, pressure shifts to the facet joints, leading to their degeneration and the development of arthritis akin to that in hip or knee joints. Bone spurs form to stabilize the deteriorating facet joints, while ligaments around the joints, known as ligamenta flava, thicken. These changes, including bone spurs and thickened ligaments, narrow the space for nerves, resulting in stenosis.

To diagnose spinal stenosis, an orthopedic surgeon conducts a comprehensive assessment:

• Gathering a detailed patient medical history.
• Performing a thorough physical examination.
• Spinal imaging techniques such as X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans.

X-rays provide insights into the bony anatomy and alignment of the spine, while MRIs offer detailed views of the spinal canal without radiation exposure. However, due to strong magnetic fields, an MRI may not be suitable for individuals with certain implants, like pacemakers. In such cases, a CT myelogram involving a contrast material injection into the spinal canal provides an alternative for visualization.

To ensure an accurate diagnosis, the surgeon also evaluates for other conditions that may mimic spinal stenosis symptoms, such as vascular claudication or osteoarthritis of the hip. This comprehensive evaluation helps tailor the treatment plan to address any underlying orthopedic issues and spinal stenosis.

There are various treatment options available for lumbar spinal stenosis, ranging from nonsurgical interventions to surgical procedures.

Nonsurgical treatments

Nonsurgical approaches commonly involve:

• Physical therapy sessions tailored to fortify the spinal stabilizing muscles and address the forward-leaning posture often adopted to alleviate nerve pressure.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen to alleviate inflammation within spinal joints and provide pain relief.
• Alleviating discomfort in the affected area using various modalities, such as ice, heat, ultrasound waves, or electrical stimulation.

While these methods do not directly expand the space within the spine, they can mitigate inflammation, alleviating pressure on the nerves and providing relief from pain. Unlike scoliosis, braces are typically not employed in treating stenosis unless instability is a concern.

Spinal injections

If conventional methods fail to bring sufficient relief, spinal injections present another nonsurgical avenue for treatment. Specialists like physiatrists, pain-management experts, or interventional radiologists administer these injections at various anatomical points. A common injection delivers a potent anti-inflammatory agent steroid directly into the affected area to alleviate inflammation and pressure. Patients are referred to a pain management group for spinal injections. 

The response to this treatment can vary, with some experiencing significant and prolonged pain relief while others may have minimal or short-lived improvement. To mitigate potential side effects associated with steroid treatment, the number of injections is usually limited to three per year. Even if temporary relief is attained through injections, surgical intervention might still be considered if other options have been exhausted. 

A successful response to injection therapy can confirm the involvement of stenosis in the patient’s condition, paving the way for surgical consideration as a last resort.

What is the Surgery for Lumbar Spinal Stenosis?

Surgical intervention aims to alleviate pressure on the spinal cord or nerve roots, thereby relieving associated pain and fatigue caused by stenosis and restoring mobility and quality of life. A common procedure is a laminectomy, which involves removing the lamina, the bony “roof” of the spine. 

Additionally, surgeons may address bone spurs and compressive soft tissues, such as bulging discs or inflamed ligaments, to further decompress the spinal cord and nerves. Advancements in surgical techniques, like minimally invasive spinal surgery, enable more targeted decompressions with smaller incisions and less tissue disruption, tailored to each patient’s needs.

The extent of stenosis varies, affecting different spine levels, from single segments to extensive regions extending to the sacrum. Depending on the severity and other factors like spinal instability, fusion procedures may also be necessary alongside a laminectomy.

Depending on the surgical plan, patients may have a short hospital stay or even go home the same day after decompressive surgery. Early physical therapy focuses on improving mobility and then moves on to strengthening and stabilizing the muscles around the spine. After surgery, patients are advised to refrain from bending, twisting, and lifting for a certain period as determined by their surgical plan.

The success rate for surgical stenosis treatment is approximately 85%, with varying degrees of improvement observed. While not all patients may return to their previous level of physical activity, many regain the ability to perform daily tasks comfortably, offering pain relief and a psychological boost through improved mobility and quality of life.

If you have any questions or concerns about your lower back pain or suspect you have lumbar spinal stenosis, don’t hesitate to schedule an appointment at Coastal Orthopedics. Our team is dedicated to providing personalized care and effective treatment options to help you find relief and regain mobility. Take the first step towards a pain-free life.