Spinal Stenosis

Your spinal cord is a bundle of nerves that runs through a tunnel formed by your vertebrae. The tunnel is called the spinal canal. Lumbar spinal stenosis is a narrowing of the spinal canal in the lower part of your back. This narrowing could be caused by a disc herniation, overgrown ligament, or bone spurring.  Stenosis can cause pressure on your spinal cord or the nerves that go from your spinal cord to your muscles.

Spinal stenosis can happen in any part of your spine but is most common in the lower back. This part of your spine is called your lumbar area. Five lumbar vertebrae connect your upper spine to your pelvis.

If you have lumbar spinal stenosis, you may have trouble walking distances or find that you need to lean forward to ease pressure on your lower back. You may also have pain or numbness in your legs. In more severe cases, you may have difficulty controlling your bowel and bladder. There is no cure for lumbar spinal stenosis, but you have many treatment choices.

The most common cause of spinal stenosis is osteoarthritis. This is the gradual wear and tear that happens to your joints over time. Spinal stenosis is common because osteoarthritis begins to cause changes in most people’s spine by age 50. That's why most people who develop symptoms of spinal stenosis are 50 or older. Some people are also born with a spinal canal that may be narrower than other people's.

Besides osteoarthritis, other conditions or things can cause spinal stenosis:

• Narrow spinal canal.

• Injury to the spine.

• Spinal tumor.

• Certain bone diseases.

• Past surgery of the spine.

• Rheumatoid arthritis.

Early lumbar spinal stenosis may have no symptoms. In most people, symptoms develop gradually over time. Symptoms may include:

• Pain in the back.
• Burning pain going into the buttocks and down into the legs (sciatica).
• Numbness, tingling, cramping, or weakness in the legs.
• Loss of sensation in the feet.
• A weakness in a foot that causes the foot to slap down when walking. This is also called foot drop.
• Loss of sexual ability.

Pressure on nerves in the lumbar region can also cause more serious symptoms known as cauda equina syndrome. If you have any of these symptoms, you need to get medical attention right away:

• Loss of bowel or bladder control.
• Severe or increasing numbness between your legs, inner thighs, and back of the legs.
• Severe pain and weakness that spreads into one or both legs. This makes it hard to walk or get out of a chair.

To diagnose lumbar spinal stenosis, your healthcare provider will ask you questions about your symptoms and do a complete physical exam. During the physical exam, your healthcare provider will look for signs of spinal stenosis, such as loss of sensation, weakness, and abnormal reflexes.

These tests help make a diagnosis:

• X-rays of your lumbar spine. These may show bone growths called spurs that push on spinal nerves, a narrowing of the spinal canal, or both.

• Imaging tests. A CT scan or MRI scan can give a more detailed look at the spinal canal and nerve structures.

• Other studies. Your healthcare provider might order a bone scan, myelogram (a CT taken after injecting dye into the spinal canal), nerve conduction studies, and electromyography (EMG), an electrical test of muscle activity).

If you have lumbar spinal stenosis, many types of healthcare professionals can help you, such as arthritis specialists, nerve specialists, surgeons, and physical therapists. Treatment can include physical therapy, medicine, and sometimes surgery. Except in emergencies, such as cauda equina syndrome, surgery is usually a last resort.

• Physical therapy may include exercises to strengthen your back, stomach, and leg muscles. Learning how to do activities safely, using braces to support your back, stretching, and massage may also be helpful.

• Medicines may include nonsteroidal, anti-inflammatory medicines (NSAIDs) that relieve pain and swelling, and steroid injections that reduce swelling.

• Surgery includes removing bone spurs and widening the space between vertebrae (laminectomy). The lower back may also be stabilized by fusing together some of the vertebrae. In some cases, fusion is used along with decompression. Decompression is easing the pressure on the nerves.

Common surgical procedures used to treat spinal stenosis:

• Decompression. This is a surgery that involves removing the bone and soft tissues of the spine that are pinching the nerves. This procedure is also referred to as a laminectomy and could be performed minimally invasively through very small incisions.  Most patients undergoing this procedure usually go home the same day. 

• Spinal fusion. This surgery is done as a last resort when there is a contributing deformity of the vertebra or curvature of the spine and involves permanently fusing two or more vertebrae together. Screws and rods may be used to hold the bones together while they mend, and can also speed recovery time.

While there is a treatment for spinal stenosis, prevention should be a primary focus. Staying physically fit and getting regular exercise can contribute to a healthier spine by improving endurance and strengthening the back muscles. Maintaining a healthy weight can also help. It reduces the load placed on the spine. Don't smoke because it can cause  the spine to break down faster than the normal aging process.

Because almost everyone has some osteoarthritis of the spine by age 50, you can’t really prevent lumbar spinal stenosis. But you may be able to lower your risk. Here are some ways to keep your spine healthy:

• Get regular exercise. Exercise strengthens the muscles that support your lower back and helps keep your spine flexible. Aerobic exercises like walking, swimming, cycling, and weight training are all good for your back.

• Maintain good posture. Learn how to safely lift heavy objects. Also, sleep on a firm mattress and sit in a chair that supports the natural curves of your back.

• Maintain a healthy weight. Extra weight puts more stress on your back and can contribute to developing symptoms of lumbar spinal stenosis.

The best way to manage lumbar spinal stenosis is to learn as much as you can about your disease, work closely with your medical team, and take an active role in your treatment.

Keep your lower back as healthy as possible by maintaining a healthy weight, practicing good body mechanics, and getting regular exercise.

Simple home remedies like an ice bag, heating pad, massage, or a long, hot shower can help. The nutritional supplements glucosamine and chondroitin have been recommended as nutritional supplements for osteoarthritis, but recent studies have been disappointing. Ask your healthcare provider if you should try any nutritional supplements and discuss any alternative treatments or medicines you’re thinking about trying.

Lumbar spinal stenosis can cause cauda equina syndrome, which needs medical attention right away. Call your healthcare provider if you have:

• Loss of bowel or bladder control.

• Severe or increasing numbness between your legs, inner thighs, or back of your legs.

• Severe pain and weakness that spreads into one or both legs, making it hard to walk or get out of a chair.