Lumbar Stenosis

What Is It?

Lumbar stenosis is a narrowing of the spinal canal which protects the spinal cord and spinal nerve roots. Spinal stenosis can occur in many areas but is most commonly found in the cervical spine and in the lumbar spine. Because the spinal cord ends at the upper lumbar spine, most of the lumbar spine does not protect the spinal cord. Instead, only the long spinal nerve roots run through the spinal canal in this area. Therefore, whereas cervical stenosis can involve the spinal cord itself, in the lumbar spine, stenosis only typically affects the nerves.

Lumbar stenosis typically results from degenerative changes that occur in the spine over years, due to aging and wear and tear. Over time, lumbar disc herniations or bulges, inflammation and overgrowth of soft tissues and ligaments, and overgrowth of bone (osteophytes) can build up on the spine. This excess and bulging tissue can eventually start to compromise the normal space within the spinal canal. If it becomes severe enough, this narrowing of the canal can begin to compress the nervous system structures, primarily the spinal nerves in the lumbar spine.

What Types of Symptoms Are Typical?

Lumbar stenosis can occur simultaneously with low back pain, but much more associated with it are symptoms in the legs. The symptoms can be in only one leg or both and can include muscle weakness, numbness and tingling and/or pain, often in multiple distributions of the arms. If very severe, the stenosis can compress the nerves to the bowel and bladder, causing bowel and bladder dysfunction such as incontinence.

In some patients, these lower extremity (leg) symptoms become worse with prolonged use. Sometimes termed neurological claudication, this means that the aching, sensory and motor symptoms can become worse when exercising or walking but get better with prolonged rest.

How Is The Diagnosis Typically Made?

Patients who present with symptoms suggestive of lumbar stenosis are usually worked up with a neurological evaluation and a CT scan or MRI scan. An MRI scan is particularly good at evaluating the spinal canal, the spinal cord and the nerves coming and going from the spine. Associated pathologies can also be seen and other diagnoses, such as a tumor or lumbar herniated disc, can be ruled out.

Occasionally tests such as a nerve conduction study may be performed to evaluate the function of the nerves and to determine which nerve root levels are most affected and may benefit from surgery or other treatments.

What Are Some Common Treatments?

The treatment of lumbar stenosis is highly individualized depending on the specifics of each case. In mild cases, simple rest, physical therapy, anti-inflammatory medications or spinal injections may be sufficient to reduce symptoms. However, for some patients with more severe disease or who fail these conservative measures, surgery may be recommended. The specific type of surgery depends on the specific anatomical characteristics and symptomatology of each case.

One of the common procedures used for stenosis is a laminectomy, removal of the posterior part of the spine bone and soft tissues to open up the canal and give the nerve roots more room. The number of levels opened in a laminectomy depends on the length of stenosis. In some cases a fusion with metal screws and rods will be performed at the same time or at a latter date.

Finally, because compression of the nerves in the foramina (foraminal stenosis), the openings through which nerves pass from the spine, can often occur concurrently with lumbar stenosis, foramenotomies at the affected levels in addition to a laminectomy may also help to decrease nerve compression and improve symptoms.

Each case and patient is different. Therefore, treatment decisions should be made with each patient's own treating physician.

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Important Note: This site is not intended to offer medical advice. Every patient is different, and only your personal physician can help to counsel you about what is best for your situation. What we offer is general reference information about various disorders and treatments for your education.

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