Lumbar spinal stenosis: What can be done?
Written in association with:
Orthopaedic surgeon
Published: 15/01/2021
Edited by: Cameron Gibson-Watt
Lumbar spinal stenosis is a condition mainly affecting people over 50. It occurs in the lower back and can bring about a variety of troublesome symptoms that make walking and carrying out day-to-day activities painful and difficult.
So, how can this pain and discomfort be treated? Leading spinal surgeon Mr Amarjit Anand walks us through the symptoms, how it's diagnosed and what treatments options are available.
What is spinal stenosis?
Lumbar spinal stenosis is a condition where the spinal canal becomes narrow, causing compression of the nerves that travel from the low back into the legs. This is usually caused by enlargement (hypertrophy) of the underlying facet joints, ligamentum flavum and/or disc prolapse resulting in narrowing (stenosis) of the nerves within the spinal canal.
What are the symptoms?
The symptoms can vary from person to person. Some people with spinal stenosis don’t have any symptoms, while others may experience the following:
Low back pain Aches and pains in your legs Reduced walking speed and walking distance (neurogenic claudication) Pins and needles in your legs (paraesthesia) Numbness in your feet Weakness in your legs, making it difficult to get up from seated position and needing to use devices to aid walking, such as a walking stick. A tendency to fall A tendency to bend forwards
Symptoms often start gradually and worsen over time. In addition to the above symptoms, you may experience the following in the later stages of the condition.
Inability to walk Bladder and/or bowel dysfunction
What happens if spinal stenosis is left untreated?
If spinal stenosis is left untreated, over time you will begin to notice significant reduced mobility and function. It can also lead to permanent nerve damage resulting in leg weakness, numbness and pain.
Moreover, progressive spinal stenosis can lead to being wheelchair-bound and bladder/bowel incontinence.
Who is most at risk of spinal stenosis?
Spinal stenosis is a degenerative condition and typically affects people who are older than 50 years old. It can affect younger people with congenitally narrow spinal canals or with those who have sustained disc injuries in their early life.
How is spinal stenosis diagnosed?
The diagnosis of spinal stenosis involves a doctor looking into your medical history, carrying out an examination and confirming their diagnosis with imaging tests.
An MRI scan is considered the gold standard to confirm spinal stenosis. It can detect the damage to your discs and ligaments and also show where the nerves in the spine are being compressed.
A CT scan can also be used for patients who cannot undergo an MRI scan. This test combines X-ray images taken from various angles to produce detailed CD image of your spine.
What treatment is there for spinal stenosis?
The treatment you undergo will depend on the symptoms experienced and severity of the stenosis. If your symptoms are mild, you may be able to manage them non-operatively, however, surgery may be necessary in some cases.
Non-operative treatment
Early treatment involves physiotherapy to develop your core strength and leg muscles to encourage you to walk as much as possible. You may benefit from getting a recumbent stationary bike to increase neural demand to the legs and may help preserve strength in the legs.
Steroid injections into the spine can be offered to help reduce nerve inflammation, irritation and pain. They do not cure the stenosis, but may help relieve symptoms. Steroid injections do not work for everyone, however, if they are effective, can be repeated and can help prevent surgery is some patients with milder symptoms.
Operative treatment
Minimally invasive lumbar decompression surgery is a very common and safe procedure to relieve compression of the spinal nerves. It is performed under general anaesthesia and through a small incision in the lower back. The way the surgeon decompresses the spinal nerve will depend on your condition. They may remove a section of bone (laminectomy and partial facetectomy), ligament (flavectomy) and/or damaged disc (discectomy) to relieve pressure on a nerve, or they may fuse two or more vertebrae with a section of bone to help stabilise and strengthen your spine.
Your recovery will depend on the complexity of the surgery. Most people can walk the day after surgery, however, you will need to avoid strenuous activities for at least six weeks.
If you are suffering from any of the symptoms mentioned in this article, visit Mr Amarjit Anand's Top Doctors profile to book an appointment with him.