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Lumbar Spinal Stenosis Explained

October 02, 2017

Lumbar Spinal Stenosis

What is spinal stenosis of the spine?

Lumbar spinal stenosis is a narrowing of the central spinal canal in the lumbar spine (lower back) or the neuroforamina where the spinal nerves exit the spine.  Narrowing of the central canal is called central spinal stenosis.  Narrowing of the neuroforamina is called foraminal stenosis.  Narrowing in either of these areas can cause pain and/or weakness in the extremities as well as multiple other symptoms.  In more severe cases, permanent nerve damage or paralysis can occur.  Spinal stenosis can put pressure on the nerves traveling through the spinal canal and the neural foramina because of a narrowing of the canal or foramina. The most common sites for spinal stenosis of the lumbar spine in the cervical spine (low back and neck).

What is the cause of lumbar spinal stenosis?

Degenerative disc disease and degeneration of the other structures in and around the spine is the most common cause of lumbar spinal stenosis. Degenerative changes are a normal part of the aging process in the body usually accommodates these changes without a large loss in function and with only mild pain as the years go by. However, in some people, the combination of these changes results in a significant narrowing of the spinal canal or the neuroforaminal openings to a degree that the nerves or the spinal cord are impinged or compressed. When this occurs, the person is said to have lumbar spinal stenosis.

Can spinal stenosis be caused by an injury?

Lumbar spinal stenosis can be caused by trauma or injury to the spine. Such trauma may involve a motor vehicle accident or fall. Other possible injuries may occur when a disc is herniated due to a personal lifting while not using proper technique. Such injuries may result in the nerves or spinal cord being compressed, resulting in lumbar spinal stenosis.

Is Spinal Stenosis bad?

There are several degrees of severity with lumbar spinal stenosis. This severity can range from very mild to very severe. In most cases, the mild to moderate degrees of stenosis caused little if any reduction in overall function. Usually, in these cases, there is little if any pain associated with the narrowing of the spinal canal or neural foramina caused by the stenosis. The person may, however, have pain associated with herniated discs or arthritic degenerative joints. With the more severe cases of spinal stenosis, there may be pain associated with activity and sometimes even at rest. One of the classic symptoms of lumbar spinal stenosis is known as neurogenic claudication. With this condition, the nerves do not get enough blood supply during activities such as walking. Therefore, when the person walks, they begin to have both pain and weakness with extended exertion. However, when they sit down for a few minutes, the problem resolved and they are able to get up and walk for a distance once again. However, when more blood supply is needed during this next bout of activity, the pain and weakness resume. In very severe cases,  a condition known as cauda equina syndrome may occur.   In cauda equina syndrome, nerve damage can occur that may result in incontinence of bowel and/or bladder control as well as possible paralysis. If these symptoms occur, it is a medical emergency that must be treated quickly, usually with surgery, in order to prevent the symptoms from being permanent. Sometimes, however, even with appropriate and timely surgical intervention, the nerve damage can be irreversible.

Can exercise help spinal stenosis?

Doctors often refer people with spinal stenosis to physical therapists or prescribe home exercise programs. Some physical therapy protocols may be beneficial with lumbar spinal stenosis. Although the exercise will not reverse the degeneration, some protocols can help decrease the extent of bulging discs and can help strengthen the core muscles that support the spine. Exercise may be conducted either in the setting of a physical therapy office, with home physical therapy, or with a home exercise program. If exercise brings on pain or other symptoms, the person should not try to "work through the pain". Instead, they should discuss these occurrences with their physician

Can physical therapy cure spinal stenosis?

Physical therapy does not usually "cure" lumbar spinal stenosis. The therapy may help strengthen muscles, improve coordination, improve function, and help relieve some of the pain associated with the more severe cases of lumbar spinal stenosis. Some of the techniques that physical therapist used to help patients with this condition include Williams Flexion Protocol, electrical stimulation, traction, ice, and heat among other physical therapy modalities and treatment protocols.

Is lumbar spinal stenosis curable?

While there is no cure for lumbar spinal stenosis, there are several treatments.  Many if not all of the symptoms associated with lumbar spinal stenosis such as pain and numbness in the legs can be reduced or even eliminated with these treatments. These treatments range from simple home exercise programs to extensive surgical decompression in the more severe cases.

Can you get surgery for spinal stenosis?

There are many surgical options for lumbar spinal stenosis, depending on where the narrowing is occurring and the severity of stenosis. Many of the surgical treatments such as the MILD technique or minimally invasive endoscopic laminectomy techniques can be performed with small incisions and relatively short recovery times. In other cases, more extensive surgical decompression is necessary. Sometimes, there is residual pain that has to be treated as well. This may require medications, further therapy, injections, or neuromodulation with devices such as spinal cord stimulators.

How long does it take to recover from a back operation?

Most people are able to return to a reasonable degree of activity fairly quickly. However, it usually takes several months for the healing in bones to reach maximum strength. It is not uncommon for some patients to take up to a year or more to obtain maximum improvement. While some of the minimally invasive surgeries may require only a few days for a person can return to sedentary activity, more extensive surgeries such as laminectomies and surgical fusions usually require people to be off work for at least 4-6 weeks. The person has a strenuous job, they may be able to return to light-duty after 4-6 weeks but it may take significantly longer for them to be able to return to full duty. Even with successful surgery, some people may not be able to return to their former level of activity, especially if their job required them to do a large amount of heavy lifting, bending, and twisting. For these individuals, it may be necessary to find a job that has lower physical requirements.

How do you prevent spinal stenosis?

Some factors that lead to lumbar spinal stenosis can be prevented but others cannot. Avoiding trauma is the most obvious way to prevent spinal stenosis from occurring. However, there does seem to be a genetic component that current technology cannot prevent. Some of the factors that can help prevent the development or worsening of lumbar spinal stenosis include avoiding tobacco. Use of tobacco products, even smokeless, has been linked to increased back, poor healing, and accelerated degeneration of the spine. Good posture can help prevent degeneration of the lumbar spine to some degree. This is because good posture helps avoid uneven pressures on the various structures of the spine. Regular exercise helps maintain both flexibility and good muscle tone to support the lumbar spine. Finally, maintaining a healthy weight is important since obesity add significantly to the weight burden that the spine has to support year after year. These lifestyle changes can both help prevent and may help reduce the symptoms of lumbar spinal stenosis.
References:
Spinal stenosis - Overview - Mayo Clinic
Lumbar Spinal Stenosis: Learn About Symptoms and Surgery
The Good and Bad News About Spinal Stenosis - Everyday Health
Exercises for Lumbar Spinal Stenosis - Spine-Health
Lumbar Spinal Stenosis | Johns Hopkins Medicine Health Library
Spinal Stenosis Causes | Osteoarthritis, Herniated Disc, Spinal Injury
Lumbar Spinal Stenosis-Prevention - WebMD
Lumbar Spinal Stenosis: Should I Have Surgery? | Michigan Medicine
Physical Therapy for Spinal Stenosis-Topic Overview - WebMD
Spine surgery - discharge: MedlinePlus Medical Encyclopedia
About the Author
Dr. John B. Adams is board certified in Pain Management by the American Board of Medical Specialties and the American Board of Interventional Pain Physicians. With almost 2 decades of experience, he offers patients access to state-of-the-art pain management, emphasizing a multidisciplinary approach to pain management utilizing precision injections, neuromodulation technology, physical therapy, behavioral medicine and judicious use of medications including help with patients titrating off opiates (narcotic pain medications).

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