Lumbar Spinal Stenosis

Lumbar stenosis causes, symptoms and treatment options

Lumbar spinal stenosis is caused by a narrowing of the spinal canal, or the space that the spinal cord sits in. The result of this is that the spinal cord gets squeezed and it is this that gives you the symptoms of lumbar spinal canal stenosis.

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This narrowing can be caused by a number of different things but tends to be something you are born with (congenital) or something you get as a result of aging or injury (acquired). The most common type is the acquired type. And the most common reasons for this are the following changes associated with aging:

  spinal stenosis

  • The ligaments in the spine become thickened, in particular the ligamentum flavum, a large ligament that runs down the back of the length of the spinal canal.

  • The facet joints respond to aging by thickening and growing more bone, or osteophytes

  • The spinal discs age and become thinner, flatter and sometimes bulge into the spinal canal.

  • Occasionally, a vertebrae may slip backwards slightly, this is called spondylolisthesis..

Symptoms of lumbar spinal canal stenosis

These can be variable but usually include pain, pins and needles and numbness in one or both legs.

Symptoms can also include sensations of weakness or loss of power in the legs - sometimes leading to the symptoms of drop foot.

Often the pain and symptoms are worsened with activity that puts your spine into extension (an upright or backward leaning position). Examples are walking or standing.

Very commonly patients with spinal stenosis complain that they get pain when they walk, especially uphill, and that it is eased immediately with bending forward or sitting.

Case example

Mr Smith was a 75 year old man who came to see me with pains in both legs and feelings of numbness in his feet. These symptoms had come on gradually over the last two years and had become worse recently. The symptoms were worse when walking and especially bad every morning when he took his dog for a walk.  He would be able to walk for about 500 yards and his pain would come on, so he would bend over to stroke the dog or fiddle with its collar for a few minutes and the symptoms would ease. He could then walk another 500 yards.

Diagnosis

Diagnosis needs to be done by combining a good clinical history with a thorough examination, including neurological tests.  MRI scan will show if the spinal canal has narrowed but is far from definitive as many people have spinal canal narrowing but have no symptoms. The MRI taken with the examination and history may be more conclusive. Sometimes electromyographic studies (looking at nerve conduction etc) are helpful.

Spinal stenosis symptoms may be similar to symptoms caused by a reduction in blood supply to the legs (vascular disease and intermittent claudication) therefore it is important that this is ruled out.

Treatment

For mild lumbar spinal stenosis conservative treatment is recommended. This involves physiotherapy to try and improve spinal movement and advice on daily activities.

Switching to a softer mattress is sometimes helpful at relieving night pain.

If this fails steroid injections are sometimes helpful although there is a lack of good evidence to show they work effectively for everyone.

If conservative treatment fails then spinal surgery is the next option.

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31-Aug-2012