Lumbar Spinal Stenosis
Spinal stenosis causes low back and leg pain
Lumbar spinal stenosis develops when the spinal canal and/or neuroforamen (nerve passageways) in the low back become narrow placing pressure on the spinal cord and/or nerve roots. Most people who have spinal stenosis have acquired it as a result of growing older, although a few individuals are born with a spinal stenosis (congenital spinal stenosis).
- Spinal arthritis (osteoarthritis, spondylitis) may contribute to bony spurs that develop on the facet joints.
- Bone spurs (called osteophytes) may encroach the spinal canal and/or lumbar nerve roots, and compress the spinal cord and/or nerves.
- Degenerative disc disease in the low back may contribute to lumbar spinal stenosis. A disc may herniate near the foramen, a nerve passageway, compressing or entrapping a spinal nerve root.
- Spondylolisthesis (eg, vertebral body slides forward over the one beneath it)
- Degenerative lumbar scoliosis
- Patients with congenital spinal stenosis (eg, achondroplasia, short stature) may develop symptoms as early as age 15.
- When the spinal cord and/or nerve roots are compressed, pain and other symptoms often develop.
Lumbar spinal stenosis often affects one last three levels of the low back: L3-L4, L4-L5, and L5-S1. Sometimes more than one level is affected.
Red areas illustrate spinal cord/nerve root
compression caused by Lumbar Spinal Stenosis
Symptoms of Low Back Spinal Stenosis
Low back pain may spread into the buttocks, legs, and calves. Leg and calf pain is sometimes called spinal claudication. A complaint from many patients with lumbar spinal stenosis is they are not able to walk a great distance, such as several blocks before leg pain starts. Even after sitting or resting, leg pain returns after walking for a while.
Leg pain may be described as radiating, sciatic-like, or cramping. Pain varies between mild and severe, and may be constant or episodic, such as when walking. Rarely does spinal stenosis cause paralysis. However, with time, pain and symptoms may worsen (eg, numbness, weakness).
Spine surgery may be recommended if non-operative therapies (eg, spinal injections) are ineffective, and/or symptoms are severe and progressive. There are different types of surgical procedures your orthopaedic spine surgeon or neurosurgeon may choose to treat your lumbar spinal stenosis. The type of procedure is dependent on the cause of the spinal stenosis.
- Decompression removes bone and/or disc material pressing on the spinal cord and/or nerve roots, and enlarges the neuroforamen (nerve passageways).
- Degenerative disc disease or spondylolisthesis may contribute to spinal instability.
- The surgical procedure may involve spinal fusion and instrumentation to stabilize the lumbar spine.
- An interspinous process device may be surgically implanted at the back of the spine between two spinous processes to increase the space where nerve root exit the spinal column.
After Spine Surgery
There is discomfort and post-operative pain, especially the first couple of days after surgery. Where you are hospitalized or recovering at home, your surgeon prescribes medication to help ease inflammation and pain. Some patients, depending on the complexity of surgery and general health, are sitting up and getting out of bed the day after surgery. Activity is started gradually with assistance and as tolerated.