What is Lumbar Spinal Stenosis

By Dr. Sabrina Walski-Easton

Lumbar spinal stenosis is a narrowing of the spinal canal in the low back. It is often associated with degenerative disease or “wear and tear” of the spine. When degenerative changes occur:

Ligaments and joints thicken or enlarge
Bone spurs (osteophytes) grow
Discs collapse or bulge
Vertebrae may slip over one another (spondylolisthesis)

It can cause pressure on nerves that may result in pain or damage.

Symptoms of Lumbar Stenosis

Some symptoms you may experience include:

Radicular (or nerve pain) down one or both legs
Numbness or tingling(pins and needles) in legs or buttocks
A dull ache in the back that spreads to your legs
Weakness or fatigue in your legs when walking
Loss of balance
Decreased endurance

Symptoms are precipitated by walking or standing and relieved by sitting down or leaning forward on a walker or cart. It is called Neurogenic Intermittent Claudication (NIC).

Diagnosing

Your doctor will perform a complete history and physical and may order imaging tests including X-ray, CT scan, MRI, or Myelogram.

Treatment Options

Once a diagnosis is confirmed, many treatment options exist.

Conservative Treatments:

1. Medications:

NSAIDS (non-steroidal anti-inflammatory drugs) and analgesics reduce pain and inflammation.
Nerve medications
Steroid medications

2. Epidural steroid Injections:

A long acting slow release steroid medication is injected into the spinal canal at the level of spinal narrowing. This reduces inflammation and can relieve symptoms. Relief is variable in duration. Up to 3 injections may be given in a 6 month period.

3. Physical Therapy

Physical therapy and exercises help improve mobility, strengthen muscles, stabilize the spine, increase flexibility and increase endurance.

Surgery Options:
NOTE: Please consult your surgeon to see if you qualify for one of these surgeries. There may be other surgeries that you may benefit from.

Interspinous Process Decompression: X-Stop

X-stop is a minimally invasive device for patients aged 50 or older with Neurogenic Intermittent Claudication (NIC) secondary to confirmed lumbar spinal stenosis and who have failed six months of conservative therapy.

A small oval spacer is placed between the spinous processes of the low back to relieve pressure on the nerves and improve symptoms. There is no removal of bone or ligament, and it is not positioned close to the nerves or spinal cord. It is inserted through a small incision in your back, and can be done under local or general anesthesia. It typically takes 45 minutes to an hour and a half to insert and many patients go home the same day. It is a fully reversible procedure the does not limit future surgical or non-surgical therapies. The device can be removed. Your doctor can determine if you are a candidate.

Follow this link to learn more about X-Stop:
http://www.kyphon.com/pdfs/X-STOP_patientguide.pdf

Laminectomy

The most common surgical procedure for spinal stenosis is a laminectomy. It can be performed at one or multiple levels and on one or both sides. The procedure involves the removal of bone, ligament and/or joint to relieve pressure on the nerves and open the spinal canal.