Low back pain is a very common problem these days. The prime cause of this pain is lumbar spinal stenosis. The narrowing of the spinal canal causes compression of the nerves that are moving from the lower back into the legs is termed as lumbar spinal stenosis. This condition can be seen in younger patients but usually it is seen as a degenerative condition in older people who are 60 or above. Due to aging, the disc becomes less spongy and results in reduced disc height. This also results in hardening and bulging of the disc into the spinal canal.
Lumbar spinal stenosis can be categorized into two types- Degenrative (age-related) and the other is Congenital (present at birth). Degenerative is most common than congenital.
What are the symptoms of Lumbar Spinal Stenosis ?
The symptoms of lumbar spinal stenosis can be seen when the back of a person is in extension and also when he stands up straight or walk. By leaning forward or sitting may provide some relief to the patient. The following symptoms can radiate through the lower back into the legs –
- Dull cramping Pain
- Difficulty with balance
- Stiffness
- Pins and needle sensation or uncomfortable tingling sensation
- Weakness Numbness
What causes Lumbar Spinal Stenosis ?
The most common cause of spinal stenosis is Arthritis. The condition of arthritis develops when the disc degenerates and also water content decreases. The water content is very high in young adults and children. The natural aging process results in drying up of the water and also weakens the disc. Due to these reasons, the disc spaces collapses and loses its space height. Other conditions can also affect lumbar spinal stenosis which decreases the space of the vertebral foramen or spinal canal such as –
- Different metabolic disorders that result in Paget’s disease of bone.
- Tumor which is an unusual enlargement of the structures which makes the spinal canal.
- Infection
Diagnosis of Lumbar Spinal Stenosis
The complete physical examination and history of a patient is evaluated. The severity of the condition and the presence of numbness or weakness can be determined with the help of patient’s physical exam. Patients having lumbar or cervical stenosis are required to take tests of either CT scan or MRI scan with myelogram. Sensation and abnormalities in strength can be evaluated by a neurological exam. Also nerve conduction studies or electromyogram (EMG) may be required for identifying irritation or damage of the nerves due to continuing compression from spinal stenosis. This also helps in determining the involved nerves.
Surgical Treatment Lumbar Spinal Stenosis
Patients who are facing weakness and pain are considered for the surgery. Some patients also find it difficult to walk for a long time without sitting. Spinal fusion and Laminectomy are the two surgical approaches for lumbar spinal stenosis. Both these surgical approaches have resulted in great relief from pain.
Spinal Fusion: When arthritis has advanced to spinal instability then spinal fusion or stabilization and decompression are suggested. During spinal fusion surgery, 2 or more vertebrae are fused or healed together. In order to fuse the vertebrae, a bone graft is taken from the hip bone or pelvis. The motion in between the vertebrae is eliminated by fusion. Also the slippage can be prevented that gets worse after surgery. While fusing the bones together, screws and rods can also be used for holding the spine in place. The usage of screws and rods help in fusing the bones quickly and also speeds up recovery.
Laminectomy: The bone spurs, ligaments and bone are removed which are responsible for compressing the nerves. Laminectomy, also referred to as decompression, may also be done as open surgery where a single large incision is used for accessing the spine. Minimally invasive procedure can also be used for performing the procedure of laminectomy. Many small incisions are made for performing minimally invasive method.
Nonsurgical Treatment for Lumbar Spinal Stenosis
There are many treatment options that provide relief from pain and also restore function. Nonsurgical methods offer relief from the symptoms of lumbar spinal stenosis.
Lumbar traction: For some patients, lumbar traction has proved beneficial but at the same time it has limited results.
Steroid injections: The most powerful anti-inflammatory is cortisone. The injections of cortisone in the epidural space or around the nerves may reduce pain as well as swelling. These injections should not be taken for more than three times in a year. Cortisone injections will reduce numbness or pain in the legs.
Anti-inflammatory Medications: Anti-inflammatory medications are used for decreasing swelling or inflammation around the nerve that provides relieve from pain. Non-steroidal anti-inflammatory drugs (NSAIDs) are used for 5-10 days for eliminating inflammatory effect.
Acupuncture: In order to treat less severe cases of lumbar stenosis, acupuncture is considered as very helpful. Acupuncture has been regarded as a very safe nonsurgical treatment.
Physical Therapy: The symptoms can be managed by performing physical therapies such as massage, abdominal strengthening, stretching exercises and lumbar strengthening.
Chiropractic manipulation: This is a very safe nonsurgical method. If a patient is suffering from disc herniation or osteoporosis then extra care should be taken. In the cases of disc herniation or osteoporosis, manipulation of the spine can result in injuries or can even worsen symptoms.
New Advanced Surgical Approaches for Lumbar Spinal Stenosis
Minimally Invasive Decompression: This can be done by making small incisions. The benefits of this procedure are faster recovery period and reduced hospital stay. This is because less injury is caused to the surrounding soft tissues.
Interspinous Process Devices: These devices are considered as a minimally invasive surgical method for treating lumbar stenosis. In the middle of spinous processes into the back of the spine, a spacer is fitted. The purpose is to keep the nerve space open by spreading the vertebrae apart. The success of this procedure depends upon the selection of an appropriate candidate in whose pain returns upon standing.
Benefits of Lumbar Spinal Stenosis
Relief from pain is one the major benefit of lumbar spinal stenosis surgery. The other benefit is that patients who have mild lumbar spinal stenosis surgery are able to return to their home on the same day and begin routine activities after some days. The recovery in the case of mild stenosis treatment is much faster as compared to open surgical procedures. The mild decompression procedure is considered as a low-risk and safe treatment.
Cost of Lumbar Spinal Stenosis
The surgery for lumbar spinal stenosis in India is performed at a very affordable cost with all modern healthcare facilities. Some of the best spine surgery hospitals are found in the major cities of India.