What is lumbar spinal stenosis?

Lumbar Spinal Stenosis

Lumbar spinal stenosis: Overview

Stenosis in the spine is a narrowing of the canal that is around the spinal cord and nerve roots in your back. It can happen as part of aging. Sometimes bone and other tissue grow into this canal and press on the nerves that branch out from the spinal cord. This can cause pain, numbness, and weakness. When it happens in the lower part of your back, it is called lumbar spinal stenosis. It can cause problems in the legs, feet, and rear end (buttocks).

You may be able to get relief from the symptoms of spinal stenosis by taking medicine. Your doctor may suggest physical therapy and exercises to keep your spine strong and flexible. Some people try steroid shots to reduce swelling. If pain and numbness in your legs are still so bad that you cannot do your normal activities, you may need surgery.

What happens when you have lumbar spinal stenosis?

Narrowing of the spinal canal can squeeze and irritate the nerve roots that branch out from the spinal cord. This is what causes pain and other symptoms. It usually starts gradually and gets worse over time. Symptoms may stay the same, get better, or get worse. Most often, it doesn't cause disabilities.

What are the symptoms of lumbar spinal stenosis?

The most common symptom of lumbar spinal stenosis is leg pain that happens when you walk or stand but feels better when you sit. You feel pain in your legs because the nerve roots that pass through the lower spine extend to the legs. Symptoms occur when these nerve roots get squeezed.

Other symptoms may include:

  • Numbness, weakness, and cramping in the legs, feet, or buttocks.
  • Stiffness in the legs and thighs.
  • Low back pain.
  • In severe cases, loss of bladder and bowel control.

Many people, especially those older than age 50, have some narrowing of the spinal canal but don't have symptoms. If there are symptoms, they may be very bad at times and not so bad at other times.

How is lumbar spinal stenosis treated?

Treatments for lumbar spinal stenosis include:

Medicines to help manage pain.
Medicines include NSAIDs and acetaminophen.
Physical therapy.
This includes stretching and strength exercises that may reduce pain and other symptoms.
Steroid shots (injections).
If other nonsurgical treatments haven't worked, these shots are sometimes tried to help leg pain by reducing inflammation in the nerve root. They may work for some people. But they may work for only a short time.
Surgery to relieve pressure on the nerve roots.
Unless the symptoms are disabling, most people with lumbar spinal stenosis don't need surgery. Surgery is most often used to relieve pain, numbness, or weakness in the legs.
Interspinous process devices.
These small devices can be put between the bones of the spine to take pressure off the nerve roots. This may be an option for some people.

Exercise and changing the way you do your activities may also help you feel better.

How is lumbar spinal stenosis diagnosed?

The doctor can usually diagnose lumbar spinal stenosis by:

  • Asking about your history of symptoms.
  • Doing a physical exam.
  • Using imaging tests. These take different kinds of pictures of your body. Tests may include:
    • MRI, to check your spinal nerves and look for disc problems.
    • CT scan, to check your bones and joints.
    • X-rays, to check for arthritis or injuries to the bones of the spine (vertebrae).
    • Bone scan, to rule out cancer and other bone diseases.
    • Electromyogram and nerve conduction tests, to see if other problems may be causing or adding to your symptoms.

Your doctor may try nonsurgical treatment, such as pain-relieving medicines, exercise, and physical therapy, for a period of time before ordering imaging tests. If treatment works, you may not need tests.

How can you care for yourself when you have lumbar spinal stenosis?

You can take steps to treat lumbar spinal stenosis symptoms at home. Be sure to talk with your doctor before you start home treatment.

Steps you can try include:

Changing the way you do your activities.
This means trying other ways of doing your activities—ways that don't cause pain or make other symptoms worse. For example, this might mean using a tall stool for tasks that you would normally do standing up. Or you could use a shopping cart or a wheeled walker so that you're leaning forward a little when you walk.
Taking medicines to manage pain.
Medicines include nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. NSAIDs, such as ibuprofen and naproxen, seem to be the best over-the-counter pain medicines. But if you can't take NSAIDs, you can try acetaminophen. Be safe with medicines. Read and follow all instructions on the label.
You can try walking on a treadmill with a slight incline. Or you could ride a stationary bike. In both of these types of exercise, your spine tilts forward a little as you work out. So they might be more comfortable for you than other exercises. Your doctor or physical therapist may also teach you exercises to improve strength and flexibility.
Limiting activities that make your symptoms worse.
Depending on the severity and location of your stenosis, these activities might include walking (especially walking downhill) and standing for a length of time.
Taking steps to lower your risk of falling.
These steps include trying to remove household hazards, such as throw rugs, and clearing cluttered walkways.

Nerves most often affected by lumbar spinal stenosis

Location of nerves down legs that are most often affected by lumbar spinal stenosis

When nerve roots in the lower back (lumbar region) are squeezed, the pressure can affect nerves that extend into the legs. This can cause pain, numbness, and weakness in the legs and feet.

What increases your risk for lumbar spinal stenosis?

The risk of having lumbar spinal stenosis increases if you:

  • Are older than age 50.
  • Have a history of spinal injury.
  • Have arthritis of the spine, which can damage the joints.
  • Have a bone disease that may soften the spinal bones or cause calcium deposits to form. Examples include:
    • Paget's disease.
    • Ankylosing spondylitis.
  • Are born with spondylolysis.
  • Have an abnormally narrow spinal canal. This may be inherited or may develop in curvature of the spine (scoliosis).
  • Have a genetic (inherited) disorder in which the bones of the arms and legs don't grow to normal size and the vertebrae of the spine don't grow normally. (This is called achondroplastic dwarfism.)
  • Have had lower back surgery. This may cause scarring that puts pressure on the spinal nerves. Progressive spinal stenosis may occur, even after successful back surgery.

What causes lumbar spinal stenosis?

The most common cause of lumbar spinal stenosis is changes in the spine that can happen as you get older.

These changes include thickening of soft tissues, development of bony spurs, and the slow breakdown of spinal discs and joints over time. Any of these can narrow the spinal canal.

These age-related changes often happen when you have certain disorders. For example:

  • Arthritis of the spine wears away joint cartilage and causes bony growths (spurs).
  • Certain bone diseases, such as Paget's disease and ankylosing spondylitis, may soften the spinal bones or cause too much bone to grow.

Other causes include:

  • An abnormally narrow spinal canal. This can be a genetic condition.
  • Spondylolysis. A vertebra may slide forward or backward over the bone below and may squeeze the spinal cord.
  • Spinal fracture.
  • Cancer.
  • Fibrosis. This is excess, ropy tissue much like scar tissue. It can come from having had spine surgery.

What is lumbar spinal stenosis?

Lumbar spinal stenosis is a narrowing of the spinal canal in the lower back, known as the lumbar area.

The spine is made up of bones called vertebrae. The spinal cord runs through an opening in the bones called the spinal canal. Sometimes bones and tissue grow into this canal and press on the spinal cord and/or the nerves that branch out from it. This causes pain, numbness, or weakness in the back, buttocks, legs, and feet.

How is physical therapy used to treat lumbar spinal stenosis?

Physical therapy for spinal stenosis may include stretching, strengthening exercise, and therapies like heat, ice, and massage. You'll learn different ways to do your activities so they don't cause pain. Your doctor or physical therapist will design a program. It will be based on your activity level, your physical fitness, and your pain level.

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