Lumbar Spinal Stenosis

The lumbar spine (lower back) consists of five vertebrae in the lower part of the spine between the ribs and the pelvis. Lumbar spinal stenosis is a narrowing of the spinal canal which compresses the nerves traveling through the lower back into the legs. While it may affect younger patients due to developmental causes, it is more often a degenerative condition that affects people age 60 and older. The discs may become less spongy as you age, resulting in reduced disc height and bulging of the hardened disc into the spinal canal. Currently, it is estimated that about 400,000 Americans, most over the age of 60, may be suffering from the symptoms of lumbar spinal stenosis. There are as many as 1.2 million Americans with back and leg pain related to any type of spinal stenosis.

Lumbar spinal stenosis may or may not produce symptoms, depending on the severity of your case. The narrowing of the spinal canal itself does not produce these symptoms. It is the inflammation of the nerves due to increased pressure that may cause noticeable symptoms to occur. When present, symptoms may include:

• Pain, weakness, or numbness in the legs, calves, or buttocks
• Pain radiating into one or both thighs and legs, similar to sciatica
• In rare cases, loss of motor functioning of the legs
• In rare cases, loss of normal bowel or bladder function

Pain may decrease when you bend forward, sit or lie down. Pain may get worse when you walk short distances.

Degenerative spondylolisthesis and degenerative scoliosis are two conditions associated with lumbar spinal stenosis. Degenerative spondylolisthesis (slippage of one vertebra over another) is caused by osteoarthritis of the facet joints. Most commonly, it involves the L4 slipping over the L5 vertebra. It is usually treated with the same conservative and surgical methods as lumbar spinal stenosis.

Degenerative scoliosis (curvature of the spine) occurs most frequently in the lower back and more commonly affects people age 65 and older. Back pain associated with degenerative scoliosis usually begins gradually, and is linked with activity. The curvature of the spine in this form of scoliosis is often relatively minor, so surgery is required when conservative methods fail to alleviate pain associated with the condition.

Diagnosis
Diagnosis is made by a neurosurgeon based on your history, symptoms, a physical examination, and results of tests, including the following:

X-ray: Application of radiation to produce a film or picture of a part of the body can show the structure of the vertebrae and the outline of the joints.

Computed tomography scan (CT or CAT scan): A diagnostic image created after a computer reads x-rays; can show the shape and size of the spinal canal, its contents, and the structures around it.

Magnetic resonance imaging (MRI): A diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology; can show the spinal cord, nerve roots, and surrounding areas, as well as enlargement, degeneration, and tumors.

Myleogram: An x-ray of the spinal canal following injection of a contrast material into the surrounding cerebrospinal fluid spaces; can show pressure on the spinal cord or nerves due to herniated discs, bone spurs or tumors.

Nonsurgical treatment

• Anti-inflammatory medications to reduce swelling and pain, and analgesics to relieve pain. Most pain can be treated with nonprescription medications, but if your pain is severe or persistent, your doctor may recommend prescription medications.

• Epidural injections of cortisone may be prescribed to help reduce swelling. This treatment is not recommended repeatedly and usually provides only temporary pain relief.

• Physical therapy and/or prescribed exercises may help stabilize your spine, build your endurance, and increase your flexibility. Therapy may help you resume your normal lifestyle and activities.

NeurosurgeryToday.org
August, 2005

To learn about the American Association of Neurological Surgeons Click Here