Lumbar Stenosis (Spinal Stenosis)
Lumbar spine anatomy
The lumbar spine is made of 5 vertebrae stacked upon each other, surrounded by spinal ligaments and muscles, and intervertebral discs that separate the vertebrae to provide shock absorption and smooth movement. Inside the vertebrae are holes that create the canal or tunnel that houses the spinal cord and nerve roots. Nerve roots are nerves that branch out from the spinal cord to provide messages from the brain and spinal cord to the muscles. Small joints called facet joints are stabilizing joints that connect the vertebrae to each other and permit backward motion.
Lumbar spinal stenosis is narrowing of the spinal canal (through which the spinal cord passes), typically due to changes in the spine caused by aging. This narrowing is also often accompanied by narrowing of the tunnels through which nerve roots pass (neural foramen). Compression of the spinal cord and nerve roots causes irritation and pinching, which results in low back and leg pain, including sciatica. Lumbar spinal stenosis is a progressive, disabling condition that affects 30% of adults over age 50. It is associated with substantial functional limitations of walking, disability and increases risk of falling.
However, lumbar spinal stenosis can affect younger individuals, most often men, who are born with congenitally narrow spinal canals. This is called congenital spinal stenosis, and people affected with this condition typically show lumbar spinal stenosis symptoms between ages 30 and 50. Other conditions that affect the spine (including scoliosis and injury) can increase the risk of stenosis. lumbar spinal stenosis affects quality of life and independence. A diagnosis of lumbar spinal stenosis is the most common indication for spinal surgery in adults over the age of 65.
Symptoms commonly develop over time and include:
- Claudication – leg pain while walking. Lumbar spinal stenosis impairs the ability to walk.
- Sciatica – pain that begins in the buttocks and runs down the leg and into the foot.
- Low back and leg pain, weakness and numbness and/or fatigue
- Pain that radiates into the groin, hips, buttocks, and thighs
- A heavy feeling in the legs and cramping.
- Foot drop – weakness that causes foot slapping when the foot hits the ground.
- Symptoms usually worsen with activity like walking and standing and may decrease when lying down, sitting or leaning forward.
- A rare condition called cauda equina syndrome is severe compression of the nerves that control the bowel and bladder and requires emergency surgery.
Lumbar spinal stenosis is caused by osteoarthritis. It is a degenerative condition that develops over time caused by normal wear and tear that leads to changes in the spinal canal, causing bone spurs that narrow the canal. It also causes intervertebral discs herniations, enlarged spinal ligaments, and enlarged facet joints that develop bone spurs, narrowing the spinal canal and increasing pressure on the spinal nerve roots. The condition called spondylolisthesis is when the vertebrae shift due to significant facet joint arthritis and worsens lumbar spinal stenosis.
Your Dallas Neurosurgical & Spine expert will review your medical history, discuss your symptoms, and conduct a physical exam focused on your back, and a neurological exam. X-rays will be ordered to assess the bones. MRI imaging will confirm a narrowing of the spinal canal and or nerve root impingement. It will also reveal bulging discs, bone spurs and enlarged spinal ligaments.
Lumbar spinal stenosis causes pain and disability but only rarely causes paralysis. Early diagnosis and treatment can prevent permanent damage. When you or a loved one is suffering with low back and leg pain and is increasingly unable to find relief, contact Dallas Neurosurgical & Spine to schedule a consultation. When treatment is postponed, it can lead to a permanent loss of function and sensation, including the potential to lose the ability to walk.