Condition: Lumbar Spinal Stenosis

The Problem

Spinal stenosis refers to narrowing of the central spinal canal or the nerve root canals.  This is most frequently the result of degenerative changes.  New bone and soft tissues grow on the vertebrae to reduce the space in the spinal canal.

The narrowing can lead to symptoms that may include painful tingling, burning or numbness from the low back into one or both lower extremities.  Most commonly, this occurs when standing in one place or walking for a prolonged period.

Diagnosis

A thorough history and physical examination will suggest the diagnosis.  X-rays of the lumbar spine show general arthritic changes of bone, but cannot show narrowing of the spinal canal.  A CT scan or MRI are needed to demonstrate narrowing of the spinal canal or nerve root canals and the other degenerative changes that can give rise to the problem.

Treatment

Oral medications can help to decrease pain and inflammation.  Bending (flexion) exercises can temporarily increase the length and width of the spinal canal to help decrease symptoms.  This can be particularly useful in the long-term control of symptoms.

These treatments are often insufficient to control the symptoms of spinal stenosis, especially when spinal narrowing is advanced or has involved multiple levels of the spine.  Epidural steroid injections are useful treatment tools that involve precise delivery of anti-inflammatory medication around nerve roots or other affected spinal structures to relieve pain and inflammation.  This treatment can provide relief that can last for several months at a time, depending on the extent of underlying spinal narrowing.

Surgery may be considered if the spinal narrowing results in progressive weakness, loss of sensation or problems with bowel or bladder sensation or control.  It may also be considered when non-surgical methods do not provide sufficient relief over an extended period of time.