Lumbar Canal Stenosis

The lumbar spine (lower back) contains 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 that causes nerve compression in the lower back and legs. While it may have an impact on younger patients, because of developmental causes, it is more frequently a degenerative condition that affects people who are particularly age 60 and older.

Narrowing of the spinal canal usually takes place slowly, over many years or decades. The disks turn out to be less spongy with aging, consequent in loss of disk height and might lead to bulging of the hardened disk into the spinal canal. Bone spurs may also happen and ligaments may thicken. All of these can bring down to narrowing of the central canal and may or may not generate symptoms. Symptoms may be because of inflammation, compression of the nerve(s), or both.

  • Pain, weakness, or passiveness in the legs, calves, or buttocks
  • Spasm in the calves with walking, necessitating regular short rests to walk a distance
  • Pain radiating into one or both thighs and legs, like the lay term “sciatica”
  • In scarce cases, loss of motor functioning of the legs, loss of normal bowel or bladder function
  • Pain may better with bending forward, sitting, or lying down
Degenerative spondylolisthesis and degenerative scoliosis (curvature of the spine) are two situations that may be related to lumbar spinal stenosis. Degenerative spondylolisthesis (slippage of one vertebra over another) is the result of osteoarthritis of the facet joints. Most usually, it involves the L4 slipping over the L5 vertebra. It's usually treated the same way lumbar spinal stenosis is: with non-surgical (“conservative”) and surgical procedures. Degenerative scoliosis happens most often in the lower back and more usually affects people aged 65 and older. Back pain associated with degenerative scoliosis ordinarily begins step by step and is linked with activity. In this type of scoliosis, the curvature of the spine is frequently minimal. Surgery may be signaled when nonsurgical measures fail to better pain related to the condition.
Diagnosis is carried out by a neurosurgeon founded on history, symptoms, physical examination, and test results. Imaging studies utilized may include the following:
  • X-ray: Focuses radiation through the body to generate an image and can display the structure of the bones, alignment of the spine, and outline the joints.
  • CT scan or CAT scan: Generates images by the union of multiple X-rays together and can display the shape and size of the spinal canal, its contents, and the structures around it with information of the bony anatomy.
  • MRI: Generates images by using powerful magnets and computer technology and can display the spinal cord, nerve roots, and surrounding areas, as well as enlargement, degeneration, and tumors.
  • Myelogram: Injects contrast dye into the spinal fluid space (cerebrospinal fluid) to outline the nerves and spinal cord, and display evidence of any pressure affecting these areas; seen on X-ray, at times done with a CT scan.
  • An assemblage of time, medications, posture management, stretching, and exercise can be assistive to a galore of patients for pain flare-ups. Weight management, nicotine cessation, and bone-strengthening endeavors may also be pointed.
  • Anti-inflammatory medications can be utilized to lessen swelling and pain, and analgesics can be utilized to relieve pain. Mostly pain can be treated with non-prescription medications, but if the pain is terrible or persistent, prescription medications may be rendered.
  • Epidural injections of medications may be advised to help reduce swelling.
  • Physical therapy and/or prescribed exercises may help to steady and defend the spine, build endurance and gain flexibility. Therapy may help the patient return to a more regular way of life and activities. Usually, four to six weeks of therapy is appreciated.
A doctor may advocate surgery if non-surgical management (as described above) does not better symptoms. There are various types of spinal surgeries obtainable, and based on the specific case, a neurosurgeon will assist to determine what process might be befitting for the patient. As with any surgery, a patient’s risks consider age, overall health, and other issues, which are all taken into thought process beforehand. If a patient meets the following criteria, he or she may be considered a surgical candidate:  Back and leg pain restricts normal activity or hampers the quality of life;  Progressive neurological deficits evolve (leg weakness, foot drop, numbness in the limb);  Normal bowel and/or bladder functions are lost;  Trouble standing or walking;  Medications and physical therapy are not impelling;  The patient appears to be in good health. There are various distinct surgical procedures that can be utilized, the choice of which is impacted by the severity of the case. In a tiny percentage of patients, spinal instability may necessitate that spinal fusion is carried out — this decision, in general, is ascertained before surgery. Spinal fusion is an operation that generates a solid union between two or more vertebrae. Spinal fusion may aid in strengthening and stabilizing the spine, and might thereby help to alleviate severe and chronic back pain.
Treatments for a slipped disc vary from conservative to surgical. The treatment specifically depends on the degree of discomfort you’re experiencing and how far the disc has slipped out of place. The majority of people can alleviate slipped disc pain using an exercise program that stretches and fortify the back and surrounding muscles. A physical therapist may advise exercises that can tone up your back while reducing your pain. Taking over-the-counter pain relievers and preventing heavy lifting and aching positions can also prove helpful. While it may be alluring to abstain from all physical activity while you’re undergoing the pain or suffering of a slipped disc, this can lead to muscle weakness and joint stiffness. As an alternative, try to remain as active as possible through stretching or low-impact activities like walking.  If over-the-counter remedies fail to relieve your slipped disc pain, your doctor may prescribe stronger medications. These include:   muscle relaxers to alleviate muscle spasms   narcotics to relieve pain   nerve pain medications such as gabapentin or duloxetine If your symptoms do not improve in six weeks or if your slipped disc is impacting your muscle function, your doctor may recommend surgery. Your surgeon may take away the damaged or projected portion of the disc without removing the entire disc. This is known as a microdiscectomy. In more intense cases, your doctor may renew the disc with an artificial one or take off the disc and fuse your vertebrae together. This process, along with a laminectomy and spinal fusion, adds stability to your spinal column.
The majority of people with a slipped disc respond well to conservative treatment. Within a span of six weeks, their pain and discomfort will bit by bit lessen. Is it manageable to prevent a slipped disc? Although you may not be able to prevent a slipped disc, you can take steps to reduce your chances of acquiring one. These measures include:
  • Use safe lifting methods: Bend and lift from your knees, not your waist.
  • Keep a healthy weight.
  • Do not stay seated for long periods; get up and stretch periodically.
  • Do exercises to fortify the muscles in your back, legs, and abdomen.
The most common surgery in the lumbar spine is known as decompressive laminectomy, in which the laminae (roof) of the vertebrae are taken off to create more space for the nerves. A laminectomy can be performed with or without fusing vertebrae or removing part of a disc by a neurosurgeon. A spinal fusion with or without spinal instrumentation might be utilized to intensify fusion and support unstable areas of the spine. Other types of surgeries or techniques/methods to treat lumbar spinal stenosis consist of:  Laminotomy: Generates an opening in the bone (in the lamina) to relieve pressure on the nerve roots.  Foraminotomy: Surgical opening or enlargement of the nerve root's bone exit from the spinal canal; can be done alone or in conjunction with laminotomy/laminectomy.  Medial Facetectomy: Removal of part of the facet (bony joint) which may be overgrown, to make more space in the spinal canal.  Anterior Lumbar Interbody Fusion (ALIF) is a procedure that involves removing a degenerative disc through the lower abdomen. A structural device, made of bone, metal, carbon filter, or other materials, is set to take the adjunct place of the removed disk and packed with bone so that finally fusion between the bone (body of the vertebrae) above and below occurs.  PLIF (Posterior Lumbar Interbody Fusion): The degenerative disc is removed via the back skin, the posterior bone of the spinal canal is removed, and the nerves are retracted to return to the disc space. A structural device, made of bone, metal, carbon filter, or other materials, is set to take the supportive place of the removed disk and packed with bone, so that in the end fusion between the bone (body of the vertebrae) above and below occurs. Similar to TLIF, this is frequently done on both sides of the spine.  TLIF (Transforaminal Lumbar Interbody Fusion): The degenerative disc is removed via the back skin, the posterior bone of the spinal canal is removed, and the nerves are retracted to reach the disc space. A structural device, made of bone, metal, carbon filter, or other materials, is set to take the supportive place of the removed disk and packed with bone, so that at last fusion between the bone (body of the vertebrae) above and below occurs. Similar to PLIF, this is oft done on only one side of the spine.  Posterolateral Fusion: Places bone graft on the back and side(s) of the spine to attain a fusion.  Instrumented Fusion: Increasing the stability of the fusion assembly by using "hardware" (hooks, screws, and other devices). The potential advantages of surgery should always be weighed cautiously against the hazard of surgery and anesthesia. Even though a large percentage of lumbar spinal stenosis patients who in the end undergo surgery account for significant pain relief after surgery, there is no assurance that surgery will help every individual.