Lumbar Canal Stenosis

July 4, 2017 | By | Reply READ MORE...

Stenosis means narrowing. Lumbar canal stenosis refers to narrowing of spinal canal in lumbar spine. The decrease space leads to compression of nerve roots, blocking of the outflow of blood from around the nerve and thus causing leg pain and other symptoms.
Spinal stenosis may affect the cervical or thoracic region in which case it is known as cervical or thoracic spinal stenosis.

CAUSES:

  • Degenerative (associated with aging) s/a spondylitis, spondylolisthesis ; wherein the canal is narrowed by bony spurs
  • Disc herniation
  • Thickening of ligament of lumbar spine (especially ligamentum flavum)
  • Congenital stenosis (spinal canal smaller than normal by birth)
  • Tumors

SYMPTOMS:

  • Leg pain, with or without back or buttock pain
  • Tingling, or numbness that radiates from the lower back into the buttocks and legs
  • Weakness or heaviness in legs
  • Symptoms are aggravated by walking ,standing upright and relieved by sitting or bending forward
  • Most people with spinal stenosis can ride a bike and walk up an incline or flight of stairs without any pain. They can often walk for extended distances if they have something to lean on, like a shopping cart. However, if they are walking down an incline or flight of stairs, their symptoms will often reappear.
  • Loss of bladder and bowel control occurs in severe cases when the spinal cord gets compressed

DIAGNOSIS:

  • Complete medical history and physical examination. Conclusive diagnosis is made using imaging studies
  • Imaging Tests
    • X-rays: show aging changes, like loss of disk height or bone spurs.
    • MRI scan: can create better images of soft tissues, such as muscles, disks, nerves, and the spinal cord.
    • CT scan with myelogram: In this procedure, dye is injected into the spine to make the nerves show up more clearly.

NON-SURGICAL TREATMENT:

Activity modification –

  • Patients are usually more comfortable when flexed forward. For example, many patients can ease leg pain and discomfort when walking by leaning forward on a cane

Exercise –

  • Strengthening the muscles that bring the spine into flexion (forward bending).
    Spine is flexed by abdominal muscles. So abdominal muscle strengthening is required. Exercises should be done under the supervision of physiotherapist

  • Stationary biking can be a beneficial treatment option because patients are sitting and positioned in a flexed-forward position while exercising.

Non-steroidal anti-inflammatory drugs (NSAIDs) –

  • Reducing inflammation (swelling) around the nerve may relieve pain

Epidural injections –

  • Cortisone injections around the nerves or in the “epidural space” can decrease swelling, as well as pain.

SURGICAL TREATMENT:

Surgery for lumbar spinal stenosis should only be considered if a patient’s ability to participate in everyday activities is unacceptably reduced and a concerted effort to relieve symptoms through non operative means has been unproductive. The goal of surgery is to decompress – either directly or indirectly – the pressure on the spinal cord or spinal nerve by widening the spinal canal.

Decompression –
This procedure involves removing the bone, bone spurs, and ligaments that are compressing the nerves. following procedures could be used

  • Laminectomy
  • Foraminotomy
  • Laminotomy

Spinal fusion –
If arthritis has progressed to spinal instability, a combination of decompression and stabilization or spinal fusion may be recommended.

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