Kraus Back & Neck Institute: 281.446.3876(281.44.Neuro)

Conditions

Lumbar Stenosis

Lumbar spinal stenosis is a common cause of low back and leg pain, especially in adults 50 years of age or older. The term stenosis means narrowing, and in the spine narrowing of nerve passageways or the spinal canal can cause nerve compression.

Types of lumbar spinal stenosis

  • Lumbar foraminal stenosis occurs when something compresses a nerve exiting the spinal column through the neuroforamen. Neuroforamen are naturally created pathways at the left and right sides between two vertebrae.
  • Lumbar central canal stenosis occurs when something compresses nerves in the spinal canal.
  • Some people develop both types of lumbar spinal stenosis.

Causes

Although some people are born with spinal stenosis (called congenital spinal stenosis), most times, it develops after age 50. Stenosis may progress incidental to naturally growing older and spinal wear and tear.

Some patients have a history of low back injury or trauma. The accident may have happened months or years before the onset of stenotic symptoms.

Different disorders can cause nerve compression, such as:

  • Spinal ligaments thicken, buckle*
  • Osteophytes (bony overgrowths)
  • Bulging or herniated discs
  • Degenerative disc disease

*The ligamentum flavum is a spinal ligament that, when it thickens, can buckle and compress spinal nerve structures.

Pain and other symptoms

Some people have no symptoms; they are asymptomatic. However, lumbar spinal stenosis usually is progressive, which means symptoms gradually develop and may worsen. Low back pain may be accompanied by buttock and leg symptoms. Leg pain is radicular pain or radiculopathy.

  • Low back pain, mild to severe
  • Pain, weakness, and/or numbness in the buttocks or legs
  • Difficult and painful to walk, stand or bend backwards
  • Resting or leaning forward relieves pain
  • Sensations such as burning, tingling, or pins and needles
  • In severe cases, bladder and bowel dysfunction
  • Although rare, loss of function or paraplegia

Five sets of lumbar spinal nerves control muscle and organ system function in your lower body. These nerves, abbreviated L1 through L5, also provide sensation (feeling).

Accurate diagnosis

Consult an expert about your low back or leg pain, pre-existing spinal stenosis or changing spinal disorder. An accurate diagnosis is essential to an effective and successful treatment plan.

  • Do any family members have spinal stenosis?
  • Have you had previous back surgery?
  • When did your symptoms start and how have they changed?

Your medical history and physical and neurological examinations are very important. You and your doctor discuss your symptoms, their severity, and treatments tried. The doctor tests your reflexes and evaluates you for muscle weakness, loss of feeling, and signs of neurological injury.

Diagnostic testing may include x-rays, CT or MRI scans, or myelography to enhance the surgeon's examination of your nerve roots and spinal canal.

Treatment options

Non-surgical treatment often helps to relieve pain and symptoms. Your doctor may combine two or more therapies to maximize the success of your treatment.

Non-surgical treatments

  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Pain medication (a narcotic, painkiller)
  • Muscle relaxing medication
  • Spinal injection
  • Short-term lumbar bracing supports the spine, may help relieve pain
  • Physical therapy
  • Spinal Decompression
  • Acupuncture

When your surgeon may discuss surgical treatment

  • Spinal instability
  • Neurologic dysfunction
  • Pain and symptoms are unrelenting
  • Non-operative treatment fails and pain persists

Surgical treatment

The goal of surgery is to decompress—take pressure off—the nerve roots and/or spinal canal. Decompression is a surgical procedure that involves trimming or removing whatever is causing compression. Many procedures can be performed using minimally invasive surgical techniques and instruments. Your surgeon will discuss the most appropriate procedure for you and help you understand the possible risks and benefits.

Decompressive laminectomy removes (ectomy) the lamina to create more space around spinal nerves and/or the spinal canal. The procedure is called a decompressive laminotomy when part (otomy) of the lamina is removed.

Laminoplasty expands the size of the spinal canal by lifting one side of the lamina. This procedure retains spinal stability and reduces the need for fusion.

Foraminotomy enlarges the size of the neuroforamen to decompress nerves.
Instrumentation and fusionstabilizes the spine and may be combined with another procedure. Instrumentation utilizes implants such as interbody devices, screws, rods, or plates. Bone graft is packed around the instrumentation to help the spine heal and fuse two or more vertebrae together.

Next steps

We hope this information about lumbar spinal stenosis has answered your immediate questions. Remember, your doctor is your most valuable source to answer your questions about symptoms and your healthcare.

Gary Kraus, MD,
Neurosurgeon, is Board Certified
Meet Gary Kraus, MD
Masaki Oishi, MD,
Spine Fellowship at the University
Meet Gary Kraus, MD
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