What is lumbar stenosis?
Stenosis is a Greek term that refers to “narrowing”, sort of like clogging a pipe. Hence, lumbar stenosis is the narrowing of the spinal canal in the lumbar area of your spine.
This natural degenerative aging process is called spondylosis. Spondylosis causes alterations in the facet joints, which make them become larger. The facet joints are the bones in the back of the spine that allow your spine to twist, bend, and move in different directions. When these facets become enlarged (by forming bone spurs or from arthritis), they can impinge on and compress the lumbar spinal nerves. Aging also causes the intervertebral discs to collapse and get smaller, giving the spinal nerves less room to travel. Thickening of the spinal ligaments inside the vertebral canal can also lead to compressive forces on the spinal canal and nerves. All of these anatomical structures can become pathological and compress your lumbar spinal nerves.
As the narrowing of the spinal canal gets smaller, it may impinge on the spinal nerves, causing radiculopathy. If the condition worsens further, then this may cause the vertebrae to slip on top of each other, causing spondylolisthesis or slippage of your vertebrae. Read more about lumbar radiculopathy here.
What are the symptoms of lumbar stenosis?
If you develop pain in your legs while walking, which is relieved when you lean forward or when you stop to rest, you may have lumbar stenosis. Lumbar stenosis can also cause a number of different symptoms. Patients may report:
- increased pain, numbness, or tingling in the legs or feet when walking
- Weakness in your legs or feet
- Cramping in your legs with walking, requiring short rests to walk certain distances
- Back pain
- Loss of bowel or bladder function
How is Lumbar Spinal Stenosis Diagnosed?
In addition to taking a detailed history and performing a thorough physical exam, Dr. Webb may order imaging studies to include:
- MRI: A magnetic resonance imaging (MRI) test will allow Dr. Webb to see the areas of compression in your lumbar spine and determine what is causing the compression.
- X rays: These are helpful in identifying causes for your stenosis, evaluate the structure of your bones, and assess your alignment of your spine.
- CT scan: allows Dr. Webb to further examine the size and shape of your spinal canal as well as plan for surgery.
- Myelogram: a radiographic dye is injected into the spinal canal, which is followed by a CT scan. Dr. Webb may order this if you are unable to undergo an MRI (i.e. if you have a pacemaker or other metal objects in your body).
How is Lumbar Spinal Stenosis Treated?
Lumbar spinal stenosis can often be treated without surgery. If you start to develop progressive muscle weakness or leg pain, bowel/bladder symptoms, or if you have failed conservative treatments, then surgery may be recommended. Surgery is always the last resort.
Level I: Non-Invasive/Conservative Treatments
- Formal physical therapy
- Chiropractic Therapy
- Home exercise program
- Activity modification
- Pain medications
- Muscle relaxants
Level II: Spinal Injections
- Epidural steroid injections
- Nerve root injections
- Outpatient procedures
- Done with x-ray guidance
- 1-3 injections may be needed
Level III: Surgery
Lumbar laminectomy: This is a procedure where Dr. Webb will make a small incision along your lower back and remove bone, ligament, soft tissue, and disc herniation that is compressing your spinal cord/nerves. At times, this procedure does entail fusing your spine with screws and rods. Learn more about laminectomies here.
Anterior lumbar interbody fusion (ALIF): This is a procedure where a Vascular trained surgeon will assist Dr. Webb in going through your belly by making a small incision and accessing your spine from the front. Once at the spine, the diseased disc will be removed and replaced with either a plastic or metal cage to directly and indirectly decompress the spinal cord and nerves. Learn more about ALIFs here.
Extreme lateral interbody fusion (XLIF): This is a procedure where Dr. Webb will make a small incision on the side of your spine. Once at the spine, the diseased disc will be removed and replaced with either a plastic or metal cage to directly and indirectly decompress the spinal cord and nerves. Learn more about XLIFs here.
Transforaminal lumbar interbody fusion (TLIF): This is a procedure where Dr. Webb will make a small incision along your lower back and remove bone, ligament, soft tissue, and disc herniation that is compressing your spinal cord/nerves. Once at the spine, the diseased disc will be removed and replaced with either a plastic or metal cage to directly and indirectly decompress the spinal cord and nerves. Learn more about TLIFs here.
Posterior lumbar interbody fusion (PLIF): This is a procedure where Dr. Webb will make a small incision along your lower back and remove bone, ligament, soft tissue, and disc herniation that is compressing your spinal cord/nerves. Once at the spine, the diseased disc will be removed and replaced with either a plastic or metal cage to directly and indirectly decompress the spinal cord and nerves.