Lumbar stenosis is when the canal that carries the nerves through the lower back narrows. Common causes include bulging discs, herniated discs, arthritis, thickening of the ligament within the spine and a loss of spinal alignment with age. Lumbar spinal stenosis typically occurs as a result of aging and symptoms may develop slowly over time.
The spine is made up of 24 bones, called vertebrae, which are stacked on top of one another. These bones connect to protect the spinal cord. Muscles, ligaments, nerves and intervertebral discs are also part of your spine.
Arthritis refers to degeneration of any joint in the body and is the most common cause of spinal stenosis. As a spinal disc degenerates and loses water content arthritis can result. The cartilage that covers and protects the joints begins to wear away.
If the cartilage wears away completely, it can result in bone rubbing on bone. To make up for the lost cartilage, your body may respond by growing new bone in your facet joints to help support the vertebrae. Over time, this bone overgrowth-called spurs-may narrow the space for the nerves to pass through.
Symptoms of Lumbar Spinal Stenosis
Most people experience discomfort in the back, buttocks and legs with spinal stenosis. Often the symptoms are only in the legs. When we stand upright and walk, it tends to worsen the narrowing around the nerve, which results in some people feeling pain, cramping or weakness when they try to walk. The symptoms typically get better quickly when they sit down. Leaning forward on a shopping cart or walker can reduce discomfort as well.
Many patients will change their activities to reduce the pain. One example is riding a bike. Many patients cannot walk very far without pain but can ride a bike for hours pain free. This is due to the fact that leaning forward on the bike opens up more space around the nerves in the spine. Golfing and running tend to aggravate lumbar stenosis and are typically avoided if someone is having pain.
To determine whether you have lumbar spinal stenosis, your physician will ask you for a complete medical history and conduct a physical examination. Other tests which may be ordered to confirm your diagnosis include: X-ray, MRI or in rare cases, a CT scan.
Once someone develops pain from lumbar stenosis they most commonly tend to have that pain unless it is treated. Roughly 10 percent of patients may have a spontaneous recovery and another 20 percent may have some worsening over time. The remaining 70 percent tend to have symptoms that do not particularly improve or worsen over time. Developing a paralysis or nerve injury is very rare unless someone has severe narrowing around their nerves or had a sudden injury.
- Medications: The most effective medication to help the pain of a stenosis is a course of oral steroids such as Prednisone and Decadron. These medications can only be taken for several days at a time and the results are short lived. As a result they are used when pain is severe. Nerve medications, like Gabapentin and Lyrica, may ease the nerve pain as well. They can have the side effects of causing drowsiness, but these tend to improve after taking the medication for a few days. Anti-inflammatories, such as Motrin and Aleve, may be helpful. They function to reduce the inflammation on the nerve, just as steroids do, but they are not as strong as a steroid. These medications thin the blood and cannot be taken for one week prior to any injection or surgery. Pain medications such as Percocet and Norco tend to not reduce nerve pain. These medications are sometimes prescribed for short times as they may take the edge off the pain but most people are surprised by how little they help.
- Injections: Spinal injections can be very helpful. A spinal injection is a type of epidural that places steroid medication on the nerve where it is being pinched. This allows for a very high concentration of medicine right where it needs to be without the side effects of taking a high dose of steroid by mouth. The medicine stays active for approximately one month. The injections are very helpful in diagnosing exactly where pain is coming from in the spine. For patients that have long standing relief from injections, having several a year may be a good long-term treatment option. A common rule of thumb is that someone can have three injections a year for a spinal issue without significant risk of side effects. Make an appointment with one of our non-operative pain management physicians.
- Physical Therapy: Therapy can help reduce the symptoms of lumbar spinal stenosis. Commonly it is prescribed for one month with a recommendation that people continue to do strengthening on their own.
- Surgery: The surgeries for lumbar stenosis are very effective for reducing or eliminating the pain that stems from pressure on the nerves. Many patients choose surgery when they have not had relief from the other nonsurgical treatments. The most common surgery is called a laminectomy. It is often the best option for stenosis when someone does not have a perplexing condition such as scoliosis, spondylolisthesis or stenosis of the foramen.
Surgeons are different in their protocols for recovery. In general, it is acceptable to walk up to several miles a day immediately following surgery. Some physicians recommend a course of physical therapy and strengthening two weeks after surgery. During this time, there are still limitations on bending, lifting and twisting. All restrictions are lifted approximately six weeks after surgery.
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