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.
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.
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.
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
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