Lumbar stenosis is a narrowing of the
spinal canal in the lower part of the spine.
This narrowing places pressure on the spinal
cord and/or nerves. While some patients are
born with this narrowing, most cases of
lumbar stenosis occur in patients over the
age of 50 and are the result of aging and
"wear and tear" on the spine.
If you are considering treatment to relief
pain from spinal stenosis, please
contact us
to determine what option is best for
you, what your insurance will cover and any
additional surgery costs.
Many patients with lumbar stenosis remain
symptom-free until other conditions further
compress the spinal canal. Other conditions
that can cause compression include:
Symptoms
The symptoms of lumbar spinal stenosis
include:
-
Low back pain that eases when
bending forward or sitting.
- Pain, weakness, or numbness in the
legs, calves or buttocks.
- Burning sensations, tingling, and
pins and needles in the involved
extremity, such as a leg.
- Bladder and bowel problems (in
severe cases).
- Although rare, very severe cases can
also cause significant loss of function
or even paraplegia.
Diagnosis
The
specialists at United Back care
about your health. That is why we will use a
combination of techniques and sophisticated
technology to help make an accurate
diagnosis:
- Medical history. We will talk to you
about your symptoms, how severe they
are, and what treatments you have
already tried.
- Physical examination. You will be
carefully examined by one of our spine
specialists for limitations of movement,
problems with balance, pain, loss of
reflexes in the extremities, muscle
weakness, loss of sensation, and other
signs of spinal cord injury.
- Diagnostic tests. Generally, we
start with plain
x-rays, which allow us to rule out
other problems such as
tumors and infections. CT scans and
MRIs give us three-dimensional views of
the spine and can help detect
osteophytes and
herniated discs. With some patients
we may order a mylogram. This is a test
that involves injecting a liquid dye
into the spinal column to show where the
pressure on the nerve is occurring.
Non-Operative Treatment for
Lumbar Stenosis
Most cases of
lumbar stenosis are successfully treated
with non-surgical techniques such as pain
medications and anti-inflammatory
medications. Severe pain may also be treated
with
corticosteroids that are injected into the
lower back (i.e. epidural steroid
injections). Depending on the extent of
nerve involvement, some patients may need to
temporarily restrict their activities.
However, most patients only need to rest for
a brief time. Physical therapy exercises
will also be prescribed to help strengthen
and stabilize the spine as well build
endurance and increase flexibility.
If these non-surgical measures do not
work, we may recommend surgery. There are a
number of surgical techniques that we can
use to treat this condition. The goal of
each of these surgical treatments is to
widen the spinal canal and relieve the
pressure by removing the cause of
compression. We will, of course, discuss all
of your options with you before deciding
which procedure is best for you.
Surgical Treatment for Lumbar
Stenosis
The most common surgery for lumbar stenosis
is called a
decompressive laminectomy in which the
laminae (roof) of the vertebrae are removed,
creating more space in the spinal canal for
the nerves. If only a portion of the laminae
need to be removed, it is called a
laminotomy. If there are
herniated or bulging discs, these may
also be removed (this is called a
discectomy) to increase canal space.
Sometimes the foramen (the area where the
nerve roots exit the spinal canal) may also
need to be enlarged. This procedure is
called a
foraminotomy.
For those patients who need surgical
repair on more than one level, or who have
significant spinal instability,
spinal fusion may be required in
addition to the decompression surgery. This
traditionally involves taking a small piece
of bone (usually from the hip) and
grafting it onto the spine. More
recently, for some cases, we are using bone
substitutes such as bone morphogenetic
proteins (BMPs) to facilitate spine fusion.
Spinal implants (called instrumentation)
such as screws and rods are used to support
the spine and provide additional stability
while the fusion is healing. In most cases,
we can determine ahead of time if fusion
surgery is necessary. At United Spine &
Joint, we perform many fusions using
minimally invasive surgical techniques, thus
reducing trauma to soft tissues, reducing
blood loss, and ultimately leading to a more
rapid recovery. If a fusion is necessary, we
will discuss this with you in advance.
Recovery from Lumbar Stenosis
Surgery
At United Spine & Joint, most patients can
begin getting out of bed on the same day
that surgery is performed! Activity is
gradually increased and patients are
typically able to go home within 1-2 days
after their procedure, depending on the
extent of the surgery. As with most
surgeries, there will be some pain after the
procedure. However, we have pain medications
available that will keep you comfortable.
At home, you will need to continue to
rest. You may still need to take the pain
medications for a while. However, pain and
discomfort should gradually reduce within a
week or two after surgery. You will be
instructed on how to gradually increase your
activity. We will provide specific
instruction regarding when and how to resume
such basic activities as walking and
driving. In addition, we will discuss with
you a timetable for returning to more
advanced activities such as yard work,
sports and work.
Your health is our primary concern. Like
you, we are eager to see you return to a
healthy,
pain-free and active life. If you have
any questions about your condition, your
treatment or your recovery, do not hesitate
to contact us.
