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| Patient Education -- Lumbar Spinal
Stenosis |
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Lumbar Spinal Stenosis
Lumbar Spinal Stenosis is a narrowing of the spinal canal
which compresses the nerves traveling through the lumbar
spine into the legs. Although occasionally seen in younger
patients (between 30 and 40) from developmental causes,
it is usually a degenerative condition seen as part of
the normal body aging process that develops when patients
are 60 years or older. Common symptoms include:
• Dull to severe aching pain in the lower back or
buttocks that develops with walking or other activity
• Pain radiates into one or both thighs and legs.
• Symptoms are relieved by sitting or lying down,
and or by bending at the waist, such as when walking behind
a shopping cart.
• In rare cases, patients can lose motor functioning
the legs, bowel or bladder function.
• Many patients have modified their lifestyles, becoming
more sedentary in an effort to control their pain.
It is not uncommon for patients to have routine x-rays
as part of their initial diagnostic testing routine. They
can rule out other potential problems such as fracture,
slippage (spondylolisthesis) or tumor in the vertebrae.
However, they cannot rule out spinal stenosis. A magnetic
resonance scan (MRI) is the best screening test to evaluate
for it's presence; in those patients unable to undergo
MRI because they have implanted devices such as pacemakers,
a CTscan with intrathecal contrast (CT myelogram) is indicated.
CT scans without contrast are rarely definitive enough
to aide the decision process.
Treatments can be either conservative or surgical. Conservative
treatments include nonsteroidal anti-inflammatory medication,
physical therapy and, occasionally, epidural steroid injections.
These approaches generally provide temporary relief. For
long term relief, surgery is the choice, often providing
patients with years of relief and an improved quality
of life. In fact, a recent study showed that more than
74% of patients undergoing surgery for lumbar spinal stenosis
reported meaningful pain relief. Surgery is usually recommended
when the following conditions are met:
• Back and leg pain limits normal activity or impairs
quality of life
• Patient experiences neurologic deficit (i.e. leg
weakness and/or numbness)
• Difficulty standing or walking
• Medication and physical therapy are ineffective
• Patient is in reasonably good health
There are several different surgical procedures which
can be utilized, the choice of which is influenced by
the severity of disease. In a small percentage of patients,
spinal instability make may it necessary for a fusion
to be performed, a decision that is generally determined
prior to surgery.
Most importantly, make an informed decision. Risks may
be influenced by other complicating illnesses and preexisting
neurologic deficits. Your neurosurgeon will work with
you to determine whether or not you are a surgical candidate,
discuss the procedures and outcomes and help review the
risks. If these options create an opportunity for a fuller
more active lifestyle, then a decision to proceed is warranted.
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