Lumbar Spinal Stenosis
Neuro and Spine Surgeries
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What is Lumbar Spinal Stenosis?
Almost everyone will experience low back pain at some point in their lives. A common cause of low back pain is lumbar spinal stenosis. As we age, our spines change. These normal wear-and-tear effects of aging can lead to narrowing of the spinal canal. This condition is called spinal stenosis. 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.
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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 -
Causes Lumbar Spinal Stenosis ?
Arthritis is the most common cause of spinal stenosis. The condition of arthritis develops when the disc degenerates and also water content decreases. In the spine, arthritis can result as the disk degenerates and loses water content. In children and young adults, disks have high water content. As we get older, our disks begin to dry out and weaken. This problem causes settling, or collapse, of the disk spaces and loss of disk space height. 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.
As the spine settles, two things occur. First, weight is transferred to the facet joints behind the spinal cord. Second, the tunnels that the nerves exit through become smaller.
As the facet joints experience increased pressure, they also begin to degenerate and develop arthritis, similar to the hip or knee joint. The cartilage that covers and protects the joints wears away. If the cartilage wears away completely, it can result in bone rubbing on bone. To make up for the lost cartilage, your body may respond by growing new bone in your facet joints to help support the vertebrae. Over time, this bone overgrowth-called spurs-may narrow the space for the nerves to pass through.
Other conditions can also affect lumbar spinal stenosis which decreases the space of the vertebral foramen or spinal canal such as:
Diagnosis of Lumbar Spinal Stenosis
When a patient presents with the typical symptoms of lumbar spinal stenosis (leg pain, with or without back pain, which is aggravated by walking), a conclusive diagnosis is made using imaging studies from an MRI scan or a CT scan with myelogram (using an x-ray dye in the spinal sack fluid). Physical examination alone does not yield a conclusive lumbar stenosis diagnosis.
There are three major types of stenosis and accurate identification is vital to stenosis treatment:
Lateral stenosis - the most common type of spinal stenosis, lateral stenosis occurs when a nerve root that has left the spinal canal is compressed by either a bulging disc, herniated disc or bone protrusion beyond the foramen (a bony, hollow archway through which all spinal nerve roots run).
Central stenosis - occurring when the central canal in the lower back is choked, central stenosis may lead to compression of the cauda equina nerve roots (the bundle of roots that branch off at the bottom of the spinal cord like a horse’s tail).
Foraminal stenosis - when a nerve root in the lower back is pressed on and trapped by a bone spur in the foramen, or the opening where the nerve root leaves the spinal canal.
Treatment Lumbar Spinal Stenosis
Surgical Treatment - surgery for lumbar spinal stenosis is generally reserved for patients who have poor quality of life due to pain and weakness or you can say patients who are facing weakness and pain are considered for the surgery. Patients may complain of inability to walk for an extended length of time without sitting. This is often the reason that patients consider surgery. Some patients also find it difficult to walk for a long time without sitting.
There are two main surgical options to treat lumbar spinal stenosis: laminectomy and spinal fusion. Both options can result in excellent pain relief.
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. There is no scientific evidence of its effectiveness.
Physical Therapy - the symptoms can be managed by performing physical therapies such as massage, abdominal strengthening, stretching exercises and lumbar strengthening.
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 - acupuncture can be helpful in treating some of the pain for less severe cases of lumbar stenosis. Although it can be very safe, long-term success with this treatment has not been proven scientifically.
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 in these cases can worsen symptoms or cause other injuries.
New Advanced Surgical Approaches for Lumbar Spinal Stenosis
Minimally Invasive Decompression - decompression can be performed using smaller incisions. Recovery is often quicker with minimally invasive techniques. This is because there is less injury to the surrounding soft tissues. With these minimally invasive techniques, surgeons rely more on microscopes to see the area for surgery. They may also take X-rays during the operation.
A traditional open procedure requires more direct visualization of the patient’s anatomy, and therefore requires a larger incision. This can be more painful for the patient. The limitation of minimally invasive surgery is the degree of visualization available. If the spinal stenosis extends over a large area of the spine, an open technique is the only method that can address the problem.
The advantages of minimally invasive procedures include reduced hospital stays and recovery periods. However, both open and minimally invasive techniques relieve stenosis symptoms equally. Your doctor will be able to discuss with you the options that best meet your healthcare needs.
Interspinous Process Devices - interspinous process devices have been developed as a minimally invasive surgical option for lumbar spinal stenosis. A spacer fits between the spinous processes in the back of the spine. Its role is to keep the space for the nerves open by spreading the vertebrae apart.
Interspinous process spacers were approved in 2005. Many procedures have been performed since then. In some studies, success rates are greater than 80 percent.
Numerous spacer devices are currently being evaluated. They may be a safe alternative to an open laminectomy for some patients. Limited bone (lamina) is removed with this procedure, and it may be performed under local anesthesia. The key to success with this procedure is appropriate selection of the patients. The appropriate candidate must have relief of buttock and leg pain when sitting or bending forward. The pain returns upon standing.
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