Spinal Stenosis

Lumbar spinal stenosis is a disease that is caused by a gradual narrowing of the spinal canal. This narrowing happens as a result of the degeneration of both the facet joints and the intervertebral discs. In this condition, bone spurs, called osteophytes, which develop because of the excessive load on the intervertebral disc, grow into the spinal canal. The facet joints also enlarge as they become arthritic, which contributes to a decrease in the space available for the nerve roots. The ligaments of the spinal column, especially the ligamentum flavum, become stiff, less flexible, and thicker with age, which also contributes to spinal stenosis. These processes narrow the spinal canal and may begin to impinge and put pressure on the nerves roots and spinal cord, creating the symptoms of spinal stenosis.

In patients who have significant spinal stenosis, they will begin to notice pain in the buttocks, thigh or leg that develops with standing or walking, and improves with rest. In some cases, a patient will complain of leg pain and weakness without having any back pain. More severe symptoms of the disorder include numbness, paresthesias and weakness in the lower extremities. Certain positions can alleviate the symptoms of spinal stenosis by increasing the amount of space available for the nerves. These positions usually involve flexion of the lumbar spine and bending forward. The presentation and severity of the symptoms of spinal stenosis depends on several factors, including the original width of the spinal canal, the susceptibility of the nerves involved, and the unique functional demands of the patient and the pain tolerance of each individual patient.

Treatment Options

Many people with spinal stenosis can be effectively treated with conservative measures. However, if a patient has debilitating pain or their ability to walk has been severly impared their physician may recommend a spinal surgery. Before a patient is considered for surgery, their doctor may try one of the following conservative measures for at least three months:

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  • Physical therapy
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Rest or restricted activity
  • Back brace to provide support
  • Epidural steroid injections

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