Lumbar Stenosis

Signs and Symptoms

Stenosis, the narrowing of the bony canal that protects the spinal cord and its branching nerves, in the lower back is often characterized by radiating pain in the buttocks and legs. Frequently people afflicted with lumbar stenosis have varying degrees of low back discomfort. The pain typically occurs most often during activities and is relieved by resting, sitting or bending forward. In some cases, the pain is centralized in the lower legs and feet. In severe cases, it also can impact continence and sexual function.

Diagnosis

Doctors use two kinds of tests to diagnose spinal stenosis. Some of the tests are aimed at making sure there isn't another cause producing the symptoms. Others can indicate that the vertebral narrowing has occurred. After asking you questions about your symptoms, your doctor probably will check your reflexes, gait and other indicators of spinal problems.

Tests include:

• X-ray -- High-energy radiation is used to take pictures of the spine.

• Magnetic Resonance Imaging (MRI) -- An MRI provides detailed pictures of the spine that are produced with a powerful magnet linked to a computer.

• Computed Tomography (CT) Scan -- A CT scan uses a thin X-ray beam that rotates around the spine area. A computer processes data to construct a three-dimensional, cross-sectional image.

• Myelogram -- This is an X-ray of your spine taken after a special dye has been injected into the spinal column. It can show pressure on the spinal cord or problems with discs or vertebrae.

• Bone Scan -- This test detects areas of increased or decreased bone metabolism, which can indicate a problem in the bone such as a fracture or infection.

Treatment

The initial treatment for stenosis is to treat the symptoms rather than the condition itself. These treatments include:

• Medication such as aspirin or ibuprofen to relieve inflammation and pain
• Rest
• Physical therapy
• Posture changes such as lying with the knees drawn up to the chest or leaning forward while walking may relieve the pressure on the nerves
• Losing weight
• Epidural corticosteroid injections to reduce inflammation and relieve pain

If several months of treatment haven't improved the symptoms, and if the stenosis is severe, surgery to widen the spinal canal may be necessary. Because bone continues to deteriorate, additional treatment may be needed several years after even successful surgery. Operations used to treat stenosis include:

• Decompressive Laminectomy -- The roof of the vertebrae, called the lamina, is surgically removed. The procedure also may include removing part of the disc or fusing the vertebrae (spinal fusion).

• Foramenotomy -- The area where nerve roots leave the spinal canal, called the foramen, is removed.

• Laminoplasty -- The covering over the upper spine is elevated but not removed to allow decompression of the spinal cord and minimize the development of instability and deformity.

• Laminotomy -- Only a small portion of the lamina is removed.

• Medial Facetectomy -- Part of the spinal joints, called the facet, is partially removed to relieve pressure on the nerve roots passing underneath it.