LUMBAR SPINE STENOSIS

 

WHAT IS SPINE STENOSIS?

This is a condition where there is narrowing of the spinal canal. The spinal canal contains the spinal cord and spinal nerves.
When there is narrowing of the spinal canal the spinal cord and or spinal nerves may be compressed to cause dysfunction.

When the canal is narrowed in the lumbar spine it is known as lumbar spinal stenosis. In this area of the spine there are mainly spinal nerves, which leave the spinal cord from the level between the first and second lumbar spinal level.

WHAT CAUSES SPINE STENOSIS?

There are many causes, but the commonest is due to degeneration of the intervertebral discs, joints of spine and ligaments. This process takes many years to develop and is a form of “wear and tear”. The intervertebral discs become weak with age, bulge out and cause bony spurs to grow from the joints. The ligaments and joint capsules thicken. These all eventually may cause narrowing of the spinal canal.

WHAT ARE THE SYMPTOMS?

In some patients no symptoms are caused, but in others symptoms may include combinations of the following:

Backache, which may be present for many years and may improve with age, leg pain and or numbness and or a feeling of tingling (pin and needles) in the legs; leg cramps. Weakness in the legs or feet may occur. There may also be disturbance of control of the bowel and bladder.

The above symptoms and signs are commonly brought on by prolonged standing in the erect position or walking. These symptoms may be persistent and worsen with time and may come and go. They may typically improve by bending forward, stopping walking and bending forward, or sitting down.

THE DIAGNOSIS

This is made by your doctor who will take into account your complaints and findings of a physical examination.

X-rays may be helpful in making the diagnosis and this can be more definitively made by special tests such as MRI (Magnetic Resonance Imaging) of the lumbar spine, or a C.A.T. (Computed Axial Tomography) scan of the lumbar spine and or a Myelogram.

WHAT TREATMENTS ARE AVAILABLE?

If your doctor has determined that your symptoms are the result of lumbar spine stenosis a number of treatment options may be considered.

NON-SURGICAL TREATMENT

Your doctor most likely will first start with a non-surgical form of treatment. This will attempt to afford pain relief by using pain killers (analgesics), anti-inflammatory medicines and physical therapy (physiotherapy). Physiotherapy and occupational therapy would have the aims of improving the muscle strength and endurance in your legs in an attempt to normalize your life style.

Please remember that all medication such as pain killers and anti-inflammatory medication do have side-effects, which your doctor will explain.

Remember that lumbar spinal stenosis is not a life threatening condition, but can alter your life style significantly. Conservative treatment must be given time to assess improvement. At least 3 months of treatment may be required.

SURGICAL TREATMENT

The aim of this treatment is to physically widen your spinal canal by taking away the bony elements (laminectomy or decompression of the spine canal). This gives the nerves more space and improves the blood flow in the spine canal.

Spine surgery is usually reserved for failure of the non-surgical treatment plan and in cases where there is progressive weakness of the legs and bowel and bladder sphincter symptoms.

If necessary you may also need a spinal fusion with the decompression if your surgeon thinks that your spine is unstable or may become unstable after the decompression.

It is important to emphasize that not all patients improve after spine surgery, some may even deteriorate.

A physical program is required after spine surgery. Just like taking medicine, surgery can have complications. These should be discussed with you before you have surgery.