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The vertebrae are the bones that make up the lumbar spine (low back). The spinal canal runs through the vertebrae and contains the nerves supplying sensation and strength to the legs. Between the vertebrae are intervertebral discs and the spinal facet joints. The discs become less spongy and less fluid-filled with age. This can result in reduced disc height and bulging of the hardened disc into the spinal canal. The bones and ligaments of the spinal facet joints can thicken and enlarge due to arthritis, also pushing into the spinal canal. These changes cause narrowing of the lumbar spinal canal which is known as spinal stenosis. Spinal stenosis is like the lime build-up on the inside of a garden hose. Over time, it narrows the diameter of the hose, just as spinal stenosis narrows the spinal canal. Spinal stenosis does not necessarily cause symptoms. Many people can have significant stenosis on imaging studies but fail to have symptoms. When present, symptoms may include pain or numbness in the back and/or legs, or cramping in the legs. Weakness in the legs may also occur. Rarely, bowel and/or bladder problems can occur. Symptoms are often worse with prolonged standing or walking. Symptoms may come and go and may vary in severity when present. Bending forward or sitting increases the room in the spinal canal and may lead to reduced pain or complete relief from pain. Your physician will take a history and perform a physical examination. X-rays may be ordered that may reveal evidence of narrowed discs and/or thickened facet joints. A magnetic resonance imaging (MRI) study may be obtained for a more detailed evaluation of spinal structures, or a computed axial tomography (CT) scan and/or lumbar myelogram may be advised for similar improved detail. Each of these studies can provide information about the presence, location and extent of spinal canal narrowing and nerve root pressure. If your doctor determines that lumbar spinal stenosis is causing your pain, he or she will usually try non-surgical treatments at first. These treatments may include anti-inflammatory medications (orally or by injection) to reduce associated swelling or analgesic drugs to control pain. Physical therapy may be prescribed with goals of improving your strength, endurance and flexibility so that you can maintain or resume a more normal lifestyle. Spinal injections (such as an epidural injection of cortisone) may be prescribed. Medication and Pain Management Your doctor may use one medication or a combination of medications as part of your treatment plan. Medications used to control pain are called analgesics. Most pain can be treated with non-prescription medications such as aspirin, ibuprofen, naproxen or acetaminophen. Some analgesics, referred to as nonsteroidal anti-inflammatory drugs, or NSAIDs, are also used to reduce swelling or inflammation that may occur. These include aspirin, ibuprofen, naproxen and a variety of prescription drugs. If your doctor gives you analgesics or anti-inflammatory medications, you should watch for side effects such as stomach upset or bleeding. Chronic use of prescription or over-the-counter analgesics or NSAIDs should be monitored by your physician for the development of any potential problems. If you have severe, persistent pain that is not relieved other analgesics or NSAIDs, your doctor might prescribe narcotic analgesics (such as codeine) for a short time. Take only the medication amount that is prescribed. Taking a larger dosage does not help you recover faster. Side effects can include nausea, constipation, dizziness and drowsiness and use may result in dependency. All medication should be taken only as directed. Make sure you tell your doctor about any kind of medications you are taking, even over-the-counter drugs, and inform your doctor whether or not your medication is working for you. There are other medications that have an anti-inflammatory effect. Corticosteroid medications (either orally or by injection) are sometimes prescribed for more severe back and leg pain because of their very powerful anti-inflammatory effect. Corticosteroids, like NSAIDs, can have side effects. Risks and benefits of this medication should be discussed with your physician. Selected spinal injections, or blocks, may be used to relieve symptoms of pain. These are injections of corticosteroid medication into the epidural space (the area in the spinal canal surrounding the spinal nerves) or facet joints and are performed by a doctor with special training in this technique. Depending on your response to the initial injection, several follow-up procedures may be performed at later dates. Injections are often done as part of a comprehensive rehabilitation and treatment program. Symptoms of spinal stenosis frequently result in avoidance of activity. This results in reduced flexibility, strength and cardiovascular endurance. Physical therapy or an exercise program usually begins with stretching exercises to restore flexibility and to tighten muscles. You may be advised to stretch frequently to maintain flexibility gains. Cardiovascular (aerobic) exercise, such as stationary bicycling or walking on a treadmill, may be added to build endurance and improve circulation to the nerves. Improved blood supply to the nerves may alleviate the symptoms of spinal stenosis. You may also be given specific strengthening exercises for the muscles of the back, abdomen and legs. Everyday activities can be less challenging if flexibility, strength and endurance are optimized. Your therapist and/or physician may advise you on how best to incorporate a maintenance exercise program into your life, either at home using simple fitness equipment, or at a fitness facility. Unless significant or progressive leg weakness develops, or bowel or bladder problems occur, the presence of spinal stenosis by itself usually does not represent a dangerous condition in an adult. Therefore, treatment is aimed at pain reduction and increasing the patient's ability to function. Non-surgical treatments do not correct the spinal canal narrowing of spinal stenosis itself, but may provide long-lasting pain control and improved life function without requiring more invasive treatment. A comprehensive program may require three or more months of supervised treatment. Surgery is reserved for that small percentage of patients whose pain cannot be relieved by non-surgical treatment methods. Surgery will also be advised for those individuals who develop progressive leg weakness or bowel and bladder problems. Since
spinal stenosis is a narrowing of the bony canal, the goal of the
surgery is to open up the bony canal to improve available space
to the nerves. This is called lumbar decompression surgery, or laminectomy.
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