Lumbar Stenosis

1. What is Lumbar Spinal Stenosis?

Lumbar spinal stenosis is a condition where the spinal canal in the lower back becomes narrowed. This narrowing can put pressure on the spinal cord or the nerves that travel into the legs, leading to pain, numbness, or weakness. It is most common in adults over 50 but can occur earlier in life due to injury or congenital factors.

2. Causes

The main causes of lumbar spinal stenosis include:

• Age-related degeneration of the spine.

• Arthritis, which can cause thickened ligaments and bone spurs.

• Herniated or bulging discs that press into the spinal canal.

• Thickened ligaments that reduce available space for nerves.

• Spinal injuries or congenital narrowing of the spinal canal.

3. Symptoms

Symptoms often develop gradually and may include:

• Lower back pain that worsens with standing or walking.

• Numbness, tingling, or weakness in the legs or feet.

• Cramping or heaviness in the legs after walking short distances (neurogenic claudication).

• Relief of symptoms when sitting or bending forward.

• In severe cases, difficulty with balance or bladder/bowel control (medical emergency).

4. Diagnosis

To confirm lumbar stenosis, doctors may use:

• Medical history and physical exam to evaluate symptoms and mobility.

• MRI scan, the most common imaging test, to show nerve compression.

• CT scan or X-rays to identify bony changes such as arthritis or spurs.

• Electromyography (EMG) if nerve function testing is needed.

5. Treatments

Non-Surgical Treatments

Most patients begin with conservative care, which may include:

• Medications such as anti-inflammatories, pain relievers, or nerve pain agents.

• Physical therapy to strengthen the back and core, improve flexibility, and support posture.

• Activity modification, including leaning forward or using a walker to relieve symptoms.

• Epidural steroid injections to reduce inflammation and relieve nerve pain.

Surgical Treatments

If symptoms persist or significantly affect quality of life, surgery may be recommended. Modern surgical approaches focus on relieving pressure while minimizing damage to surrounding tissues:

• Microdecompression: a minimally invasive spine surgery technique that uses small incisions and specialized instruments to free compressed nerves.

• Endoscopic decompression: performed through a tiny incision with the help of a camera, reducing recovery time.

• Minimally invasive spinal fusion (if needed): stabilizes the spine in cases of severe degeneration or instability.

These minimally invasive spine surgery options are designed to reduce postoperative pain, shorten hospital stays, and allow patients to return to normal activity faster compared to traditional open surgery.