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Lumbar Spinal Stenosis

    At a Glance

    • Lumbar spinal stenosis is a common condition that can cause a range of problems, some serious and severe.
    • The condition develops over time, leading to the narrowing of the spinal canal.
    • Symptoms can include back pain, numbness, weakness and difficulty walking even short distances.
    • It is sometimes called “the great masquerader” since it can mimic several other conditions.
    • Although a potentially crippling problem, spinal stenosis is very treatable.
    • Treatments range from medication and physical therapy, to procedures like nerve blocks and surgery.

     

     

    Symptoms of Lumbar Spinal Stenosis

    Patients often discover they have spinal stenosis when they begin experiencing generalized low back pain and difficulty standing up straight. They also may have extremity numbness, weakness, balance problems, poor posture, difficulty walking any distances, and often, a combination of these symptoms. It is seen most commonly over the age of 55.

    Some patients may report sciatic nerve pain, an uncomfortable condition that may be experienced starting from the lower back through the buttocks, legs and feet. It is often described as a “stiff back.”

    In severe cases, spinal stenosis leads to a loss of muscle mass and/or problems with bowel and bladder function.

    If left untreated, severe spinal stenosis can cause neurological problems that can affect our ability to function normally.

    Doctors often call spinal stenosis “the great masquerader,” as it sometimes mimics other conditions such as peripheral vascular disease (a narrowing and hardening of the arteries leading to the legs and feet), neuropathy (damaged or diseased peripheral nerves and nerve endings), or arthritis of the major joints.

     

    Causes

    Lumbar spinal stenosis is a potentially crippling condition that usually results from years of arthritis and degenerative disease. Bone spurs, inflamed and enlarged tissue, synovial cysts, excessive amounts of fat in the spine, and bulging discs all may create a narrowing of the spinal canal, creating a stenosis.

    Sometimes the problems are caused by scar tissue forming after a previous surgery, spine fracture or deformity. Degenerative spinal stenosis is not a problem by itself; rather, it is the result of underlying conditions creating a stenosis, such as those mentioned above.

    Central Spinal Stenosis is a collective term that refers to narrowing of the spinal canal thereby decreasing the space available for the spinal cord and spinal nerves. Central spinal stenosis is usually caused by combinations of bone spurs from the facet joints, thickening of the Ligamentum flavum (a soft tissue structure covering the backside of the spinal canal), and bulging of the intervertebral disc.

    If an excessive amount of bone spurs from around the facet joint, they can occupy and narrow the foraminal canal that is formed by the facet joint above and below each vertebra. This narrowing can cause pinching of the exiting nerve root that is trying to exit the spine on its way to one of extremities. If symptoms of a pinched nerve occur due to this condition, it is called foraminal stenosis. Foraminal stenosis can be an isolated problem or seen in conjunction with central spinal stenosis.

    Lateral recess stenosis may also be seen with central spinal stenosis, causing the spinal nerves entering the intervertebral foramen to be pinched.

    There is also a more rare type of spinal stenosis that some people are born with called congenital stenosis.

    Obesity, poor nutrition, lack of exercise, smoking, and medical conditions, such as diabetes, cardiovascular disease, osteoporosis, and thyroid disorders all may be contributing factors.

    In all cases, problems develop due to the constriction or squeezing of the spinal cord or spinal nerves. Doctors call lumbar spinal stenosis “angina of the spine,” referring to the chest pain that develops due to the narrowing of the arteries in the heart.

    However, in the back, the spinal canal becomes narrowed to the point where blood flow is restricted to the spinal cord and spinal nerves causing the symptoms. Another analogy would be a transient ischemic attack (TIA) or stroke in the brain, which also is a circulation problem.

    There are three types of degenerative spinal stenosis: central spinal canal, lateral recess stenosis, and foraminal stenosis. More than one of these types can be present in the same patient and can occur at one or multiple locations.

    Radiculopathy

    A radiculopathy means inflammation or damage that has or is occurring to one or more of the spinal nerves that come off of the spinal cord but are still inside the spinal canal. It is usually caused by a condition that causes a focal spinal stenosis such as a herniated disc, bone spurs, cysts, and so on. It can occur anywhere in the spine.

    Myelopathy

    A myelopathy means spinal cord damage. It is usually caused by spinal stenosis in the neck or middle back and the terms are sometimes used interchangeably. “Myelopathic” is another term commonly used to describe patients with symptomatic cervical or thoracic spinal stenosis.

    This is a serious condition that needs to be treated aggressively or significant and permanent neurological damage can occur.

    Avoiding & Managing Lumbar Spinal Stenosis

    Maintaining good overall health is the best single strategy for avoiding spinal stenosis. Keeping your body weight at an ideal level, eating nutritious foods, and exercising regularly contribute to good spine health.

    Many individuals are using various natural supplements with success such as glucosamine, condroitin sulfate, vitamin D3, magnesium, curcumin, and omega-3 fatty acids to name a few.

    Whole-body exercises and activities such as yoga, Pilates and swimming offer the twin benefits of strengthening the body’s core while improving flexibility. In addition, maintaining a good sleeping environment at home and being conscious of proper posture and lifting mechanics (avoiding lifting heavy loads with the back) can be significant positive contributors as well.

    If you think you may have spinal stenosis, the first step is to consult a doctor who specializes in the spine. You may decide against surgery in favor of chiropractic care, physical therapy, and other active steps toward improvements in your condition such as epidural injections.

    If your doctor recommends physical therapy, a qualified therapist can help focus on the right kind of activities. Generally, leaning forward helps reduce pressure on the nerves by creating openings in the spinal column. In contrast, bending backward can worsen symptoms by creating compression of the spinal cord and spinal nerves.

    Back hyperextension exercises and yoga postures, such as the Cobra or Boat poses, are examples of exercises that extend or excessively arch the back and thus should be avoided.

    Lastly, if diagnosed with spinal stenosis you should probably avoid high-impact sports such as running, jogging, basketball, snow and water skiing and vigorous aerobics.

    Learn about Spinal Stenosis treatment options.

    Frequently Asked Questions

    What causes spinal stenosis?
    How is spinal stenosis diagnosed?
    Do I need surgery for spinal stenosis?
    more faqs »

    Treatment for Lumbar spinal stenosis

    The evaluation and diagnosis of spinal stenosis may require a team approach to find the cause of the problem. This is necessary to determine the most appropriate treatment, which may include non-surgical measures, intervention pain management and/or surgery.

    The doctor will likely order medical imaging studies of the spine such as an MRI, which generates a detailed view of the tissue in and around the spine, a CT scan, or a series of X-rays to provide various cross-section views of the spinal vertebrae and surrounding tissues. Sometimes all are necessary.

    Other possible tests include an EMG and nerve conduction study to determine how well nerves can send signals, an ultrasound to evaluate circulation, and a bone density test.

    Having determined the cause of the problem, the doctor has a variety of treatments at his or her command. They may be as mild as prescribing aspirin or involved as surgery.

    Non-Surgical Treatments

    The least-invasive treatments can help patients with mild forms of spinal stenosis. Sometimes, it may require just non-prescription medicine and an exercise plan. In addition, some of these therapies will also be part of a more involved treatment plan.

    These treatment options include:

    • Over the counter (OTC) medications such as ibuprofen (Advil, Motrin), naproxen (Aleve), or acetaminophen (Tyelenol)
    • Physical therapy and massage
    • Traction
    • Water exercises
    • “Core” exercise program Including Pilates and yoga
    • Aerobic conditioning and personal training
    • Medications such as anti-inflammatories (NSAIDs), cortisone, muscle relaxants, and pain killers.

     

    Pain Management Treatments

    If medications and/or physical therapy are not effective, interventional pain management procedures may help. These range from an epidural injection, a procedure where medicine is placed directly into the spinal canal, to the use of radio waves to destroy painful nerve endings. Other treatments are available depending on the severity of the condition.

    Treatment options include:

    • Selective Nerve Block
    • Caudal-Epidural
    • Epidural
    • Transforaminal Epidural
    • Facet Block and Radio Frequency Nerve Ablation
    • Spinal cord stimulator
    • Implantable pain pump

     

    Surgical Treatment

    A recent government medical study that was published found that surgery provides the best results for treating severe symptomatic spinal stenosis over both the short and long term when compared to other non-surgical treatments. It is the only treatment that gets rid of the problem: that is, removing whatever tissue and bone is causing the stenosis. This is called spinal decompression surgery.

    Some other operations like spinal fusion therapy may be necessary if there is instability or a severe deformity present. These operations can be quite involved and require months of rehabilitation. A growing number of spine surgeons are performing less invasive microdecompression surgery, which can be performed as an outpatient if the problem is minor or with just an overnight hospital stay.

    Surgical options include:

    • Traditional laminotomy, laminectomy or laminaplasty
    • Transforaminal microscopic or endoscopic decompression
    • Percutaneous discectomy
    • Microdecompression laminaplasty
    • Micro endoscopic decompression – MED
    • Indirect spinal distraction decompression – X-Stop
    • Simple spinal fusion
    • Spinal fusion with instrumentation and implants

     

    Related topics

    • Central Spinal Stenosis
    • Foraminal Stenosis
    • Lateral Recess Stenosis
    • Myelopathy
    • Neurogenic claudication
    • Spondylosis
    • Stiff Back

     

    Non-Surgical Treatments

    Pain Management

    Surgical Treatments

    OTC Medicine
    Massage and Massotherapy
    Traction
    Water Exercises
    “Core” Exercise program Including Pilates and Yoga
    Aerobic Conditioning and Personal Training
    Rx Medication
    Selective Nerve Block
    Caudal-Epidural
    Epidural
    Transforaminal Epidural
    Facet Block and Radio Frequency Nerve Ablation
    Laminotomy
    Laminectomy
    Laminaplasty
    Transforaminal Micro Decompression
    Microdecompression Laminaplasty
    Micro Endoscopic Decompression – MED
    Indirect Spinal Distraction Decompression – X-Stop
    Spinal Fusion With Instrumentation and Implants
    Laser Facet Ablation

     

    Frequently Asked Questions

    Do I need surgery for spinal stenosis?
    more faqs »