What is lumbar spinal stenosis?
Lumbar spinal stenosis means narrowing of the lumbar spinal canal. As we age, the spinal canal can gradually narrow as the disc and spinal joints (known as facet joints) degenerate. The facet joints and spinal ligaments enlarge as they become more arthritic resulting in a decreased space available for the nerves that travel in the spinal canal.
How is lumbar spinal stenosis diagnosed?
Spinal stenosis is suspected when a patient complains of back pain that radiates into the buttocks and legs. In addition to pain, a patient may also experience numbness and weakness of the legs. The back and leg pain symptoms typically are made worse with standing and walking and improved with leaning forward or sitting. When we stand and walk, the joints of the spine tend to further narrow the spinal canal placing more pressure on the nerves resulting in worsening symptoms. Leaning forward and sitting places the spinal joints in flexion which increases the space in the spinal canal and therefore reduces the back and leg pain symptoms. Patients with spinal stenosis tend to lean over on their shopping carts in the grocery store enabling them to walk greater distances with less back and leg pain. An MRI is the best study to show the narrowed spinal canal from the joints, ligaments and discs. If a patient cannot have an MRI study due to metal implants, then a CAT scan is the next best study.
What is the treatment for lumbar spinal stenosis?
The treatment options will depend on the severity of the back and leg pain symptoms. For milder symptoms, conservative (nonsurgical) options such as medications, physical therapy and injections are recommended. Medications include Tylenol, anti-inflammatories (aspirin products) and muscle relaxants. Physical therapy strengthens the core muscles, improves spinal posture, and reduces muscle spasms. Epidural steroid injections can be administered several times a year to reduce local inflammation in the nerves.
For severe back and leg pain, leg weakness, and difficulty walking surgery may be a good option. The surgical procedure is known as a lumbar laminectomy. The procedure entails partial removal of the joints and ligaments that are compressing the nerves.