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Lumbar Spinal Stenosis |  | | By AANS |
Lumbar Spinal Stenosis is a narrowing of the spinal canal which compresses the nerves traveling through the lumbar spine into the legs. Although occasionally seen in younger patients (between 30 and 40) from developmental causes, it is usually a degenerative condition seen as part of the normal body aging process that develops when patients are 60 years or older. Common symptoms include:
Dull to severe aching pain in the lower back or buttocks that develops with walking or other activity
Pain radiates into one or both thighs and legs.
Symptoms are relieved by sitting or lying down, and or by bending at the waist, such as when walking behind a shopping cart.
In rare cases, patients can lose motor functioning the legs, bowel or bladder function.
Many patients have modified their lifestyles, becoming more sedentary in an effort to control their pain.
It is not uncommon for patients to have routine x-rays as part of their initial diagnostic testing routine. They can rule out other potential problems such as fracture, slippage (spondylolisthesis) or tumor in the vertebrae. However, they cannot rule out spinal stenosis. A magnetic resonance scan (MRI) is the best screening test to evaluate for it's presence; in those patients unable to undergo MRI because they have implanted devices such as pacemakers, a CTscan with intrathecal contrast (CT myelogram) is indicated. CT scans without contrast are rarely definitive enough to aide the decision process.
Treatments can be either conservative or surgical. Conservative treatments include nonsteroidal anti-inflammatory medication, physical therapy and, occasionally, epidural steroid injections. These approaches generally provide temporary relief. For long term relief, surgery is the choice, often providing patients with years of relief and an improved quality of life. In fact, a recent study showed that more than 74% of patients undergoing surgery for lumbar spinal stenosis reported meaningful pain relief. Surgery is usually recommended when the following conditions are met:
Back and leg pain limits normal activity or impairs quality of life
Patient experiences neurologic deficit (i.e. leg weakness and/or numbness)
Difficulty standing or walking
Medication and physical therapy are ineffective
Patient is in reasonably good health
There are several different surgical procedures which can be utilized, the choice of which is influenced by the severity of disease. In a small percentage of patients, spinal instability make may it necessary for a fusion to be performed, a decision that is generally determined prior to surgery.
Most importantly, make an informed decision. Risks may be influenced by other complicating illnesses and preexisting neurologic deficits. Your neurosurgeon will work with you to determine whether or not you are a surgical candidate, discuss the procedures and outcomes and help review the risks. If these options create an opportunity for a fuller more active lifestyle, then a decision to proceed is warranted.
Copyright© 1998-2000; American Association of Neurological Surgeons /
Congress of Neurological Surgeons |
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Manhattan Neurosurgical Associates, P.C.: Manhattan Neurosurgical Associates: Handout
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