Lumbar Spinal Stenosis
What is lumbar spinal stenosis?
Lumbar stenosis is a narrowing of the spine that puts pressure on the spinal canal and nerves in the lower back. This squeezing can change how the spinal cord functions and produce symptoms of pain, weakness or numbness that radiates down the low back and into the legs. Symptoms often get worse with activity and diminish with rest. Left untreated, the compression of nerves from spinal stenosis can lead to loss of function in the legs.
How does lumbar stenosis occur?
While some people are born with a small spinal canal, the most common cause of lumbar stenosis is degenerative changes in the spine related to aging. Other, less common, causes include spinal instability, disc herniation, osteoporosis, tumors, accident, traumatic injury and constriction of blood supply to the spinal cord.
What are the symptoms?
Symptoms of lumbar stenosis often start gradually and worsen over time. Common symptoms include:
- Low back pain
- Pain, weakness and numbness in the legs, feet and buttocks
- Stiffness in the legs and thighs
- Incontinence (loss of bladder or bowel control)
Symptoms typically get worse with walking or activity and lessen when sitting or leaning forward.
How is lumbar stenosis diagnosed?
In addition to a complete physical exam and patient history, your doctor can use specific tests, including X-ray, MRI and CT scan, to diagnose lumbar stenosis. Sometimes, a test called an electromyogram is used to check electrical activity along the nerves and pinpoint the area of damage.
What is the treatment?
For some patients with lumbar stenosis, non-surgical treatment is effective. This includes activity modification, weight loss, non-steroidal anti-inflammatory medication, corticosteroids, epidural injections or physical therapy. If the symptoms get worse and restrict normal activities and quality of life, surgery may be necessary. The goal of surgery is to relieve pressure on the spinal cord and nerve roots.
The most common surgical treatment is a decompressive laminectomy and fusion. In this two-part procedure, the surgeon removes the bone or fibrous tissue that is pressing on the nerves and opens up the spinal canal. The vertebrae are fused together to provide stability. In some cases, rods or screws are used to hold the vertebrae firm as the fusion heals.
Two of the most advanced fusion techniques are transforaminal lumbar interbody fusion (TLIF) and extreme lateral interbody fusion (XLIF). During TLIF, surgeons approach the spine from the side of the spinal canal through a midline incision in the patient’s back, sparing nerves and muscles. XLIF is performed through the patient’s side, avoiding the major muscles of the back.
These state-of-the-art, minimally invasive procedures take a fraction of the ordinary surgical time and offer patients a host of benefits that speed recovery. Advantages include smaller incisions, less tissue and muscle damage, less pain and bleeding, and shorter hospital stays. However, not everyone is a candidate for the XLIF or TLIF procedure. A surgeon who is trained in these techniques is the best person to determine the most appropriate surgical option for the patient. A consultation with the proper surgeon is crucial in making that determination.