Lumbar Spinal Stenosis - Overview

What is lumbar spinal stenosis?
Lumbar spinal stenosis is a narrowing of the spinal passageways in the lower back region of your spine. This narrowing can put pressure on the spinal cord and nerve roots which may cause pain and other symptoms.

What causes lumbar spinal stenosis?
Lumbar spinal stenosis is caused by changes in the shape and size of the spinal canal as people age. This natural degenerative process causes anatomical changes such as:

•  bone spur growth
•  ligament thickening
•  loss of disc height, or disk bulging

All of these conditions can lead to lumbar spinal stenosis, which can occur at any time but is most common in people over 50 years old and may continue to progress with age.

How is lumbar spinal stenosis diagnosed?
Your doctor will ask questions about your symptoms and past health and do a physical exam. You will probably need an MRI, a CT scan, and sometimes x-rays. Symptoms are most severe in extension (walking), and are relieved in flexion (sitting, bending forward).

What are the symptoms?
Common symptoms of lumbar spinal stenosis include:

•  Leg, buttock, and groin pain
•  Numbness, weakness, cramping, or stiffness in the legs, or buttocks
•  Low back pain
•  Difficulty walking or standing but experience relief in the seated or flexed position
•  In severe cases, loss of bladder and bowel control

Symptoms may be severe at times and less severe at other times. Most people will not be severely disabled. In fact, some people do not have symptoms at all.

How is it treated?
There are several treatment options available depending on the level of severity. First line treatment options for mild to moderate symptoms include:

•  Physical therapy
•  Oral pain medications
•  Spinal injections to block the pain or reduce the inflammation

Patients who don't respond to these treatments may be offered surgical options, such as:

•   Direct Decompression: surgery to remove bone and tissue that are squeezing the spinal cord. Direct decompression can help relieve leg pain and allow you to get back to normal activity, but it may not help back pain as much.
•   Fusion: sometimes a spinal fusion surgery is performed along with a direct decompression, which may require a larger incision, screw, rod or plate implants, and a longer recovery time.
•   Indirect Decompression: recently a new type of less invasive surgical treatment has become available that uses an interspinous spacer device, (indirect decompression), which preserves a patient’s anatomy and ability to maintain motion. Interspinous spacers work by repositioning the spine’s bony anatomy, relieving pressure on the affected nerves.

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In Extension

Stenosis Extension

In Flexion
(sitting, bending forward)

Stenosis Flexion