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 Understanding the Degenerative Condition of the Lower Back

What is lumbar spinal stenosis?

• Orthopaedics defines Lumbar spinal stenosis as narrowing the spinal canal in the lower back. Lumbar spinal stenosis occurs because of the degeneration of the spine, including the discs, joints, and ligaments.
• The narrowing of the spinal canal puts pressure on the spinal cord and nerves, leading to symptoms.
• Symptoms of lumbar spinal stenosis include lower back pain, leg pain or weakness, numbness or tingling in the legs or feet, and difficulty strolling or maintaining balance.
• The condition is more common in older adults, as it is often a result of age-related degeneration.
• Lumbar spinal stenosis includes arthritis, spinal injuries, genetic factors, and certain medical conditions.
• Orthopaedics diagnoses lumbar spinal stenosis based on a combination of medical history, physical examination, and imaging tests such as X-rays, MRIs, or CT scans.
• Treatment options for lumbar spinal stenosis include non-surgical approaches such as physical therapy, pain management techniques, and lifestyle modifications.
• Surgery may be necessary to alleviate symptoms and create more space in the spinal canal.
• The prognosis for lumbar spinal stenosis varies depending on the severity of the condition and individual factors. Orthopaedics uses appropriate treatment so patients can find relief from their symptoms and maintain an active lifestyle.

A Happy Lady after Lumbar Spinal Stenosis

 

What causes lumbar spinal stenosis?

• Degeneration of the spine is the prime cause of Lumbar spinal stenosis.
• The degeneration can involve various structures in the spine, including the discs, joints, and ligaments.
• Ageing is a significant contributing factor to the development of lumbar spinal stenosis.
• As a person ages, the spinal structures naturally undergo wear and tear, leading to degeneration and narrowing of the spinal canal.
• Arthritis, particularly osteoarthritis, can contribute to lumbar spinal stenosis. Arthritic changes in the spine, like the formation of bone spurs, can narrow the spinal canal.
• Spinal injuries, such as fractures or herniated discs, can cause or contribute to lumbar spinal stenosis.
• Genetic factors can play a role in the development of lumbar spinal stenosis. Some individuals may have a genetic predisposition to develop spinal degeneration at a faster rate.
• Certain medical conditions, such as Paget's disease, can lead to spinal stenosis.
• Other factors include lumbar spinal stenosis, obesity, repetitive stress on the spine, and previous spinal surgeries or procedures.
• It's important to note that lumbar spinal stenosis can have multiple contributing factors, and the specific cause can vary from person to person.

 

What are the symptoms of lumbar spinal stenosis?

• Lower back pain: Patients with lumbar spinal stenosis often experience pain in the lower back region. The pain might range from a dull ache to a sharp sensation, and its intensity can fluctuate.
• Leg pain: A common symptom is pain that radiates from the lower back into one or both legs. This pain comes down to the buttocks, thighs, calves, or feet. Doctors describe it as a burning or tingling sensation.
• Weakness in the legs: Some individuals with lumbar spinal stenosis may experience weakness in the legs. This weakness can affect mobility and make it difficult to perform activities that require strength, such as standing up from a seated position or climbing stairs.
• Numbness or tingling: Patients may experience the feeling of numbness or tingling in the legs, feet, or buttocks. These feelings can be a loss of sensation or a "pins and needles" feeling.
• Difficulty walking or maintaining balance: Lumbar spinal stenosis can cause difficulty in walking, walking long distances or standing for extended periods. Some individuals may also experience balance problems or a feeling of instability.
• Decreased endurance: Patients may notice reduced endurance for physical activities, with symptoms worsening after walking or engaging in prolonged standing or bending.
• Symptoms relieved with bending or sitting: Individuals with lumbar spinal stenosis often find relief when they sit down, lean forward, or flex their spine. This position helps to advance the spinal canal and relieve pressure on the nerves.
• Symptoms worsen with certain activities. Symptoms may worsen when engaging in activities that involve the extension of the spine, such as walking uphill or standing upright for a prolonged period.
• Bladder or bowel changes: Rarely, lumbar spinal stenosis can cause bladder or bowel dysfunction. This dysfunction may include difficulty controlling urination or bowel movements.
• It's important to note that the severity and combination of symptoms can vary among individuals with lumbar spinal stenosis. Some people may have mild symptoms, while others may experience more significant impairments.

 

How is lumbar spinal stenosis diagnosed?

• Medical history: The healthcare provider will gather information about the patient's symptoms, medical history, and any previous spine-related conditions or injuries.
• Physical examination: Experts conduct a physical test to assess the patient's range of motion, reflexes, muscle strength, and any signs of neurological abnormalities.
• Imaging tests: The surgeon diagnoses various imaging tests for lumbar spinal stenosis, including:
• X-rays can help visualise the spine's alignment, detect signs of arthritis or spinal instability, and rule out other conditions.

1. Magnetic Resonance Imaging (MRI): MRI scans provide detailed images of the spinal structures, including the spinal canal, discs, nerves, and soft tissues. They can reveal the presence of spinal stenosis, herniated discs, or other abnormalities.
2. Computed Tomography (CT) scan: CT scans can provide cross-sectional spine images, offering additional information about the bony structures and the extent of spinal stenosis.

• Electromyogram (EMG) and Nerve Conduction Studies (NCS): These tests measure the electrical activity in muscles and nerves to assess nerve function and identify any nerve-related issues.
• Provocative testing: In some cases, doctors perform provocative testing to reproduce symptoms and determine their correlation with specific movements or positions. This technique involves walking on a treadmill or leaning backwards to assess the impact on symptoms.
• Diagnostic injections: Orthopaedics may use diagnostic injections to help identify the specific source of pain and confirm the diagnosis of lumbar spinal stenosis. These injections involve the administration of anaesthetics or anti-inflammatory medications into specific spinal structures.

Doctors use the patient's symptoms as a primary criterion for diagnosing lumbar spinal stenosis, physical examination findings, and imaging results. The healthcare provider will evaluate these factors to determine the presence and severity of lumbar spinal stenosis and develop an appropriate treatment plan.

Rehabilitation and Recovery after Lumbar Spinal Stenosis

How is lumbar spinal stenosis treated?

• Doctors commonly use non-surgical treatments to manage lumbar spinal stenosis.
• They use physical therapy to improve strength, flexibility, and posture, helping to alleviate symptoms and enhance overall function.
• They employ pain management techniques, including prescribing over-the-counter or prescription medications, to reduce pain and inflammation associated with lumbar spinal stenosis.
• They may administer epidural steroid injections to provide temporary relief. It may reduce inflammation and relieve nerve compression.
• They sometimes recommend assistive devices such as canes or walkers to improve stability and balance while walking.
• They advise lifestyle modifications, including weight management and regular exercise, to help alleviate symptoms and improve overall spinal health.
• Surgeons may consider surgical intervention for severe or refractory cases of lumbar spinal stenosis.
• They offer surgical options such as decompressive procedures, like laminectomy or laminotomy, where they remove the bone or tissue compression to create more space in the spinal canal.
• In some cases, they perform spinal fusion to control the spine and address any instability caused by the surgery or pre-existing conditions.
• The choice of surgical procedure depends on various factors, including the patient's overall health, the severity of symptoms, and the underlying cause of spinal stenosis.
• Doctors typically prescribe post-surgical rehabilitation, including physical therapy and gradually increasing activity levels, to optimise recovery and restore functionality.

Patients should consult an orthopaedic surgeon to determine the specific treatment approach for lumbar spinal stenosis, considering individual circumstances and preferences.