Lumbar Spinal Stenosis

by Dr. David Bomback

Lumbar Spinal Stenosis–a common cause of lower back pain–is a narrowing of the spinal canal in the lower back.

 

lumbar spinal stenosisDegenerative lumbar spinal stenosis is a common cause of lower back pain and leg pain that is most frequently encountered in individuals older than 50. The classic symptoms include progressive back, buttock or leg pain, and lower extremity numbness or weakness which worsens with standing and walking.

While not as serious as cervical spinal stenosis–which affects the neck–lumbar spinal stenosis is still a great burden to those who suffer from it.  Since the pain can prevent you from handling common daily activities, it can seriously inhibit your independence.

Spinal stenosis is position dependent meaning that you will usually feel it more keenly when you stand and less when you sit or lay down.  Why does this happen?  When we stand upright, the diameter of the spinal canal is narrowed, resulting in compression of the spinal cord and nerves. These symptoms are typically relieved by changing to a seated or forward flexed position (like when leaning on a counter or shopping cart), since this forward flexed position increases the diameter of the spinal canal.

Stenosis is a multifactorial degenerative process. It reaches a critical impact when the spinal canal narrows due to any combination of disc degeneration, spondylolisthesis (forward slippage of one vertebra over the one below it), thickening of the perispinal ligaments, or facet joint arthritis.

The condition can affect an individual’s ability to perform daily activities, thereby lowering their quality of life and ultimately threatening their independence.

Symptoms of Lumbar Spinal Stenosis

As previously mentioned, lumbar spinal stenosis typically affects the lower body in those fifty years old and above. Common symptoms include:

  • Lower back pain, buttock pain or leg pain
  • Lower extremity numbness or weakness
  • Pain is often related to a position or activity – relief may come from ceasing movement temporarily
  • Fluctuating intensity of symptoms

Treatment of Lumbar Spinal Stenosis

Surgery should not be a first resort!  

Most patients experience relief from much less invasive treatment such as medications, activity modification, physical therapy and epidural steroid injections are the mainstay of conservative care for spinal stenosis.

Spinal stenosis isn’t a life threatening condition and, accordingly, it is not unreasonable to consider simply having the patient spend more time in a seated position. Studies show that in the majority of patients, the symptoms are likely to remain unchanged over time and that fewer than 20% of people will actually get worse.

Common Treatments

  • Medication
  • Epidural steroid injections
  • Physical therapy
  • Activity modification
  • Spinal stenosis surgery — usually as a last resort after exhausting less invasive treatment options

Since stenosis is a mechanical problem, so patients often fail to achieve sustained relief with conservative therapy because these treatment options do not alter the anatomical/mechanical pathology that causes the symptoms.  This is why surgery cannot be ruled out entirely.

Lumbar Spinal Stenosis Surgery

spinal cord and nervesPatients with persistent symptoms who fail to respond to conservative management are generally offered spinal stenosis surgery, though there are many surgical options.

The goal of surgery is to alleviate the pressure on the spinal cord and nerves while preserving stability of the spine. The conventional surgical treatment for spinal stenosis is a lumbar laminectomy where bone is removed from the posterior portion of the spinal canal in order to decompress the spinal cord and exiting nerve roots.

If the symptoms are strictly one-sided, a unilateral hemilaminectomy or foraminotomy may be performed to limit the amount of bone that is removed.

A spinal fusion may be recommended along with the decompression if your surgeon feels that removing the bone that is contributing to the stenosis will result in destabilization of that portion of the spinal column.

The X-Stop is a relatively new, FDA approved, minimally invasive procedure that provides an alternative surgical option for patients with spinal stenosis. The spinal elements are decompressed by inserting a titanium oval spacer between the adjacent spinous processes of the affected levels avoiding exposure of the spinal cord and nerves. When considering surgery, patients must take into consideration the fact that multiple medical issues, diabetes, smoking, advanced age, longer duration of compression, and severity of compression are all factors which affect nerve recovery and may be associated with less successful surgical outcomes.

Given the number of options available, we highly recommend getting a second opinion before proceeding with surgery.  You want to ensure you’re making the right choice for your lower back pain needs.

Lumbar Spinal Stenosis: Getting a Second Opinion

Identifying the issue affecting your spinal health–as well as the severity–will help determine the best treatment for you.  We can help.  Fill out the form on this page or call us today at

855-377-4767

 

Dr. David Bomback

About Dr. David Bomback

Dr. Bomback has excelled throughout his entire academic career. After graduating high school as salutatorian, he then graduated cum laude from Columbia College, Columbia University where he was named one of only five Rabi Scholars (for mathematics and science) in his class. He then earned his medical degree at Columbia College of Physicians & Surgeons,... Read More »