Spinal canal stenosis or lumbar spinal stenosis is one of the common causes of low back pain and is a condition caused by narrowing of the spinal canal due to excess bone growth or tissue such as cartilage. The spine is narrowed in one or more of three parts:
- The space at the centre of the spine
- The canals where nerves branch out from the spine
- The space between vertebrae (the bones of the spine).
Spinal stenosis is most common in men and women over 50 years old. Younger people who were born with a narrow spinal canal or who hurt their spines may also get spinal stenosis.
Causes of Spinal Stenosis can include:
- Osteoarthritis (wear and tear arthritis)
- Rheumatoid arthritis
- Congenital conditions
- Tumours of the spine
- Paget’s disease (a disease that affects the bones)
- Too much fluoride in the body
- Calcium deposits on the ligaments that run along the spine.
There may be no symptoms of spinal stenosis, or symptoms may appear slowly and get worse over time. Signs of spinal stenosis include:
- Pain in the neck or back
- Numbness, weakness, cramping, or pain in the arms or legs
- Pain going down the leg
- Foot problems.
One type of spinal stenosis, cauda equine syndrome, is a very serious condition that requires immediate medical intervention. This type occurs when there is pressure on nerves in the lower back. Symptoms may include:
- Loss of control of the bowel or bladder
- Problems having sex
- Pain, weakness, or loss of feeling in one or both legs.
If you have any of these symptoms, you should call your doctor right away.
To diagnose spinal stenosis, your doctor will ask about your medical history and conduct a physical exam. Your doctor may also order one or more tests, such as:
- X rays
- Magnetic resonance imaging (MRI) – a test that uses radio waves to look at your spine
- Computerized axial tomography (CAT) – a series of x rays that give your doctor a detailed image of your spine
- Myelogram – a test in which the doctor injects liquid dye into your spinal column
- Bone scan – a test in which you are given a shot of radioactive substance that shows where bone is breaking down or being formed.
Lumbar spinal stenosis may be treated with conservative treatment approaches such as use of pain medications, physical therapy, steroid injections, or acupuncture. In chronic cases, surgery may be required to treat the condition.
Conservative Treatment Options
There are many nonsurgical treatments for spinal stenosis. Your doctor may prescribe:
- Physical therapy:Physical Therapy involves stretching exercises, massage, and lumbar and abdominal strengthening.
- Anti-inflammatory medications: Non-steroidal anti-inflammatory drugs (NSAIDs) initially provide pain relief and also reduce swelling.
- Steroid injections: Cortisone steroid injections are given around the nerves or in the "epidural space” to decrease swelling and pain.
- Acupuncture: Acupuncture can be helpful in cases where the pain is less severe.
- Chiropractic manipulation: Chiropractic manipulation can be done in some cases but not when there is co-existing osteoporosis or herniated disc because these cases increase the symptoms or cause injuries.
Your doctor will likely suggest nonsurgical treatment first unless you have:
- Symptoms that get in the way of walking
- Problems with bowel or bladder function
- Problems with your nervous system.
Your doctor will take many factors into account in deciding if surgery is right for you. These include:
- The success of nonsurgical treatments
- The extent of the pain
- Your preferences
The two main surgical procedures to treat lumbar spinal stenosis are laminectomy and spinal fusion.
- Laminectomy: This procedure involves removal of the bone, bone spurs, and ligaments that compress the nerves.
- Spinal fusion: In this procedure, two or more vertebrae are permanently fused together.