Spine Stenosis

Lumbar Spinal Stenosis

There are five vertebrae that make up the lumbar spine, or low back. These are referred to by physicians as L1 - L5; L for lumbar, the number representing which of the vertebrae is being referred to by the physician. Lumber spinal stenosis is a narrowing of the canal formed by the vertebrae.

The causes of this condition include a congenital defect, such as having been born with a narrower spinal canal. The most common causes of lumbar spinal stenosis, however, tend to be aging and its concurrent degenerative changes, or injury. A significant percentage of lumbar spinal stenosis is due to what physicians call idiopathic (unknown) causes.

Symptoms of spinal stenosis are generally manifested as pain in the lower back and/or legs, as well as numbness, tingling, weakness or paraparesis (partial paralysis of the lower extremities.). Keep in mind, however, that not every patient will experience the same set of symptoms. This can make diagnosis rather difficult.

Diagnosis of lumber spinal stenosis is made by direct examination, description of symptoms, conventional X-rays, MRI (magnetic resonance imaging) or PET scans (positron emission tomography).

Probably the most significant aspect of this condition is pain. This can limit the ability of the patient to engage in exercise, as walking can increase symptoms. Also if the patient experiences any degree of paraparesis, walking could be nearly impossible. If the patient is unable to exercise, weight gain is a serious concern, as it increases the strain on the lumbar spine.

What can the physician offer their patient in terms of treatment? Therapies start at the very conservative - i.e., rest and heat (or ice) to the affected area. Next in the progression would be moderate exercise and physical therapy. The therapies available in the moderate range of treatment include injections of corticosteroids, but this is not effective in all cases and, in any case, has a short time frame in which it is effective, typically no longer than a month.

Surgery (for lumber spinal stenosis) is an option for treatment that should only be considered after other therapies have failed to alleviate pain. Laminectomy is most common; this is the surgical decompression of the nerve. The nerves can be pinched by impingement of bony fragments and this procedure relieves the pressure. The other surgical option offered is spinal fusion where two or more vertebrae are stabilized by use of rods and screws on either side of the spine. The first line of treatment should always be quite conservative before progressing to the alternatives of injection or surgery.

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