Lumbar Spinal Stenosis
Lumbar spinal stenosis is a condition in which the bones and/or discs in the lower back become arthritic and push on the nerves. This commonly causes severe pain in the lower back, buttocks, and/or legs. Lumbar spinal stenosis is an often-missed diagnosis, but with a proper diagnosis, treatment can relieve symptoms and improve your quality of life.
- Pain, often severe, in the lower back
- Pain may inhibit daily activities
- Tingling, weakness, or numbness in the legs
- Cramping in the legs while walking
- Symptoms tend to worsen when walking or standing for longer than a few seconds
- Symptoms may lessen when sitting down, flexing forward, or lying down
- Lower back pain that is so intense that older patients must lean over a shopping cart or another assistive device to experience relief (“shopping cart sign”)
- Symptoms usually fluctuate over time, with alternating periods of pain flareups and few or no symptoms
- Symptoms develop slowly over time (usually found in patients over age 50)
- Symptoms may progress and cause permanent numbness, weakness, incontinence, balance problems, or even paralysis
- Arthritis/osteoarthritis of the bones or discs in the lumbar spine
- Age-related wear and tear on the lumbar spine
- Gradual degeneration of bone and lumbar discs over time
- Bone spurs on the spine
- Herniated lumbar discs
- Slipped lumbar discs
- Thickened ligaments in the lumbar region
- Inflammation in the body
- Spinal injuries or deformities in younger patients (rarely)
- Conservative Treatment: Nonsurgical treatments including anti-inflammatory medications, spinal injections, weight management, posture management, stretching, physical therapy, and lifestyle modifications (such as using a cane or walker) can help patients with lumbar spinal stenosis. These treatments can manage pain flareups, build endurance, reduce swelling and inflammation, and increase flexibility. If conservative treatments prove unsuccessful, and if symptoms are severe or debilitating, surgery may be the recommended course of action.
- Lumbar Stenosis Surgery (Laminectomy): This surgery removes the excess bone and arthritic debris that are compressing the nerves of the back. This procedure relieves pressure on the spinal cord to alleviate symptoms and is the most common surgical treatment for lumbar stenosis.
- Lumbar Laminotomy: This surgery removes part of the lamina to create an opening within the bone through surgical micro-decompression.
- Lumbar Disc Replacement Surgery: This surgery replaces an arthritic, degenerative lumbar disc with a fully mobile artificial disc. Where stenosis is caused by a degenerative disc, this can improve symptoms and allows the lower back to continue moving in a natural, physiological way.
- Interspinous Process Spacer: This surgery involves the insertion of a spacer device between the spinous processes to decompress the nerves.
- Spinal Fusion: This surgery removes a degenerative disc and fuses the adjacent vertebrae together. This procedure may be recommended for patients with instability, pathologic motion, and nerve compression in the spine. Spinal fusion can alleviate symptoms but restricts some movement due to the vertebral fusion.
- Muscle Sparing and Minimally Invasive Surgery: This surgery uses a tubular retractor to allow direct access to the spine with significantly less damage to the soft tissues and muscles. The tubular system may be used for either a laminotomy or fusion procedure.
Frequently Asked Questions
“Stenosis” comes from a Greek word meaning “narrowing” or “choking”. Lumbar spinal stenosis is when the tissues of the spine go through an abnormal narrowing, usually due to degeneration associated with aging. The small stabilizing facet joints between and behind the vertebrae of the spine tend to enlarge over time and compress the nerve roots in the spine. Most often, lumbar stenosis is the result of osteoarthritis and/or degenerative spondylolisthesis (slipped disc). Most affected individuals are over age 50, although in rare cases younger patients may develop lumbar stenosis due to a spinal injury or deformities such as a curvature of the spinal canal.
The symptoms of lumbar stenosis are often misdiagnosed as other conditions, especially as problems or arthritis in the hip joints. A combination of a detailed medical history, symptom evaluation, physical examination, MRI, CT or CAT scan, X-rays, myelogram, and other evaluation methods can yield a proper diagnosis.
Conservative nonsurgical treatments are usually preferred by most patients if their day-to-day living is still largely unaffected. However, if your lumbar stenosis has significantly affected the quality of your life and nonsurgical treatment options have been unsuccessful, it may be time to consider a procedure. While traditional lumbar stenosis surgery (laminectomy) is the most common surgery, every patient’s symptoms, pathology, and options are unique. Dr. Pehler will carefully consider your situation before recommending the best lumbar stenosis surgery for you.
The details of your recovery will vary depending on the surgical technique chosen. In most cases, patients can return home within 1 to 4 days. Bending and/or twisting will be restricted for the initial few weeks. Physical therapy and pain medications will likely be part of your recovery process. Practicing sitting and progressing to walking as soon as possible is encouraged to strengthen the muscles and improve circulation as the body heals. A back brace may be placed to provide support and control pain levels. Discomfort and symptoms should improve as the tissues heal. More details will be provided for you based on your surgical plan.
While all surgery poses risks, spinal stenosis surgery is a safe and effective procedure for appropriately selected candidates. Modern technology including continuous monitoring of the nerves in the spine and minimally invasive procedures lower the risks for patients. The risks, benefits, and alternatives will be discussed with you in detail with Dr. Pehler.
Lumbar spinal stenosis may be progressive, but not always. This condition should be monitored carefully over time. If symptoms are manageable, conservative treatments can help maintain quality of life long-term. In cases where symptoms have progressed to the point that they are debilitating, spinal stenosis surgery can provide long-lasting relief.