Spinal Stenosis
What is it?
Lumbar spinal stenosis is a
narrowing of the spinal canal in the lumbar area
(low back).
Who gets it?
This narrowing is usually caused
by degenerative changes (deterioration) in the
spine (vertebrae) that occur as part of the
natural aging process. As we age, the disks
(cushions between the bones of the spine) on our
spinal column lose fluid and height. The loss of
height results in "disk bulging. The small
joints in the back part of the spine develop
osteophytes ("spurs"). The ligaments
surrounding the spinal column tend to thicken. In
combination, these changes lead to a decrease in
the space available to the nerve roots as they
travel through and exit the spinal canal. Once
the narrowing of the spinal canal gets to a
critical point, the blood supply to the nerve
roots that supply sensation and motor power to
the legs is cut off.
Spinal stenosis tends to run a
very gradual course. Symptoms may not worsen for
several years and certainly there is nothing life
threatening about this condition. It is only when
the level of symptoms becomes intolerable in
terms of limiting a person’s quality of life
that surgery should be considered.
What are the symptoms?
Patients usually experience back
and/or leg pain. In more severe cases, there may
be numbness or weakness as well. Symptoms are
typically worse when you stand and/or walk
because in this posture, the spinal canal becomes
narrower than when you bend forward or sit. Thus,
individuals with spinal stenosis find it
difficult to stand up straight or walk distances
without leg pain. Bending forward or sitting
usually relieves their pain.
Diagnosis
Plain x-ray films do not
typically show spinal stenosis. Therefore, your
doctor will order a magnetic resonance image (MRI)
or a myelogram and computerized tomogram (CT)
scan. These specific tests accurately show the
amount of stenosis. It is important for your
physician to order one of these studies to be
sure of the diagnosis and properly plan your
treatment.
Treatment
Conservative (non-operative)
treatment for spinal stenosis includes pain
medication (non-steroidal anti-inflammatories –
NSAIDs), physical therapy, and bracing. However,
when these methods of treatment fail to control
symptoms, surgery may be indicated. Only surgery
can actually widen the spinal canal.
The surgery to widen the spinal
canal is termed a "decompression". The
procedure is performed through an incision on
your back. During the procedure, the orthopaedic
surgeon removes the laminae (bony arches of the
spinal canal), and the ligaments between these
arches which may be contributing to the stenosis.
Occasionally, a portion of the damaged disk joint
itself may need to be removed. If a sufficient
amount of tissue is removed, then it may be
necessary to perform a fusion operation as well,
in order to prevent the occurrence of spinal
deformity and pain post-operatively.
Typical hospital stays for a
simple decompression surgery usually range from 1
to 3 days. After surgery, you may need to wear a
light-weight brace for comfort, however, most
patients are not required to wear a brace.
Once discharged from the
hospital, patients are able to get out of bed
independently and walk without assistance. Some
help at home for the first few weeks following
surgery is usually necessary. By six to eight
weeks after surgery, most patients find that they
are about 90% back to their full potential.
Overall, this type of surgery is
successful in eliminating leg pain and allowing
patients to walk further in about 80 to 85% of
cases. The relief of back pain is less reliable,
however, most patients do find that their back
pain is significantly decreased, if not
completely relieved.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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