Daniel K. Park, MD

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Spinal Stenosis

Lumbar Spinal Stenosis

Lumbar spinal stenosis is one of the common causes of low back pain. It is caused by the narrowing of the spinal canal which occurs as a part of aging process. The symptoms include back pain, burning or aching type of pain in buttocks that radiates to the legs (sciatica), weakness in the legs or "foot drop". Lumbar spinal stenosis may be treated with conservative treatment approaches such as use of pain medications, physical therapy, steroid injections, or acupuncture. In chronic cases, surgery may be required to treat the condition.

Spinal stenosis is most common in men and women over 50 years old. Younger people who were born with a narrow spinal canal or who hurt their spines may also get spinal stenosis.

Causes of Spinal Stenosis can include:

  • Aging
  • Osteoarthritis (wear and tear arthritis)
  • Rheumatoid arthritis
  • Congenital conditions
  • Tumors of the spine
  • Injuries
  • Paget's disease (a disease that affects the bones)
  • Too much fluoride in the body
  • Calcium deposits on the ligaments that run along the spine

Symptoms

There may be no symptoms of spinal stenosis, or symptoms may appear slowly and get worse over time. Signs of spinal stenosis include:

  • Pain in the neck or back
  • Numbness, weakness, cramping, or pain in the arms or legs
  • Pain going down the leg
  • Foot problems

One type of spinal stenosis, cauda equine syndrome, is a very serious condition that requires immediate medical intervention. This type occurs when there is pressure on nerves in the lower back. Symptoms may include:

  • Loss of control of the bowel or bladder
  • Problems having sex
  • Pain, weakness, or loss of feeling in one or both legs

If you have any of these symptoms, you should call your doctor right away.

Diagnosis

To diagnose spinal stenosis, your doctor will ask about your medical history and conduct a physical exam. Your doctor may also order one or more tests, such as:

  • X rays
  • Magnetic resonance imaging (MRI) - a test that uses radio waves to look at your spine
  • Computerized axial tomography (CAT) - a series of x rays that give your doctor a detailed image of your spine
  • Myelogram - a test in which the doctor injects liquid dye into your spinal column
  • Bone scan - a test in which you are given a shot of radioactive substance that shows where bone is breaking down or being formed

Conservative Treatment Options

There are many nonsurgical treatments for spinal stenosis. Your doctor may prescribe:

  • Medicines to reduce swelling
  • Medicines to relieve pain
  • Limits on your activity
  • Exercises and/or physical therapy
  • A brace for your lower back

Surgery

Your doctor will likely suggest nonsurgical treatment first unless you have:

  • Symptoms that get in the way of walking
  • Problems with bowel or bladder function
  • Problems with your nervous system

Your doctor will take many factors into account in deciding if surgery is right for you. These include:

  • The success of nonsurgical treatments
  • The extent of the pain
  • Your preferences

Common procedures that can be performed for spinal stenosis include:

Nonsurgical Treatment

  • Physical therapy: Physical Therapy involves stretching exercises, massage, and lumbar and abdominal strengthening
  • Anti-inflammatory medications: Non steroidal anti-inflammatory drugs (NSAIDs) initially provide pain relief and also reduce swelling
  • Steroid injections: Cortisone steroid injections are given around the nerves or in the "epidural space” to decrease swelling and pain
  • Acupuncture: Acupuncture can be helpful in cases where the pain is less severe
  • Chiropractic manipulation: Chiropractic manipulation can be done in some cases but not when there is co-existing osteoporosis or herniated disc because these cases increase the symptoms or cause injuries

Clinical Example

History: Patient is a 45 year female with a history of bilateral buttock pain worse with walking. She states she can only go grocery shopping if she pushes the cart and bends forward. If she tries to walk upright with good posture, her buttock pain increases. She denies any bowel or bladder incontinence. She has tried physical therapy and steroid injections with only temporary relief.

Images: A MRI image demonstrates at the L3-4 level, there is compression of the spinal canal. The top arrow points to a normal area. You can see a gray vertical stripe (nerves) surrounded by a white area (spinal fluid). The bottom arrow points to a compressed or stenotic area. Here there is a loss of the spinal fluid around the nerves, there is less white area around the spinal nerves.

Spinal Stenosis

Surgery: Patient underwent minimally invasive laminectomy or decompression of the spinal canal. The left image demonstrates a xray of a normal spine. On the right, this is what a xray looks after a laminectomy. The middle portion of the spine is removed to allow more room for the nerve roots. This does not cause any problems typically. The nerves are still protected from harm.

Spinal Stenosis