This topic is about spinal stenosis of the lower back, also known
as the lumbar area. If you need information on spinal stenosis of the neck, see
the topic Cervical Spinal
Stenosis.
What is lumbar spinal stenosis?
Lumbar spinal stenosis is a
narrowing of the
spinal canal in the lower
back, known as the lumbar area.
This usually happens when bone or
tissue-or both-grow in the openings in the spinal bones. This growth can
squeeze and irritate nerves that branch out from the
spinal cord.
The
result can be pain, numbness, or weakness, most often in the legs, feet, and
buttocks.
What causes lumbar spinal
stenosis?
It's most often caused by changes that can happen as people
age. For example:
Arthritis leads to the growth of bony
spurs that push on the nerves that branch out from the spinal cord.
Discs between the bones may be pushed backward into the spinal
canal.
What are the
symptoms?
Symptoms may include:
Numbness, weakness,
cramping, or pain in the legs, feet, or buttocks. These symptoms get worse when
you walk, stand straight, or lean backward. The pain gets better when you sit
down or lean forward.
Stiffness in the legs and thighs.
Low
back pain.
In severe cases, loss of bladder and bowel
control.
Symptoms may be severe at times and not as bad at other
times. Most people aren't severely disabled. In fact, many people don't have
symptoms at all.
How is lumbar spinal
stenosis diagnosed?
Your doctor can tell if you have it by asking
questions about your symptoms and past health and by doing a physical exam.
You will probably need imaging tests such as an
MRI, a
CT scan, and sometimes
X-rays.
How is it treated?
You can most likely control mild
to moderate symptoms with pain medicines, exercise, and
physical therapy. Your
doctor may also give you a spinal shot of corticosteroid, a medicine that reduces
inflammation.
You may need surgery if your symptoms get worse or if they
limit what you can do. Surgery to remove bone and tissue that are squeezing the
nerve roots can help relieve leg pain and allow you to get back to normal
activity. But it may not help back pain as much.
The most common cause of lumbar spinal stenosis is
changes in the spine that can happen as you get older.
These changes
include thickening of soft tissues, development of bony spurs, and gradual
breakdown of spinal discs
and joints. Any of these
conditions can narrow the spinal canal.
Also,
other conditions may cause spinal stenosis, such as:
An abnormally
narrow spinal canal, which can be an inherited condition.
Spondylolysis, which is
a defect or fracture on one or both of the wing-shaped parts of a vertebra. A
vertebra may slide forward or backward over the bone below and may squeeze the
spinal cord or a nerve root.
Fibrosis, which is excess, ropy tissue much like scar
tissue. It can come from having spine surgery in the
past.
Symptoms
Many people, especially those older than age 50, have some narrowing of the
spinal canal but don't have symptoms.
Symptoms occur when the nerve
roots get squeezed.
Leg pain
The most common
symptom is leg pain that happens when you walk or stand and feels better when
you sit. You feel pain in your legs, because the
nerve roots that pass through the lower
spine extend to the legs.
People often have leg pain when
the spine is extended-when they are standing straight or leaning backward, for
example.
And they often feel better when the spine is flexed-when they
are sitting, walking uphill, riding a bicycle, or leaning over a grocery cart,
for example.
People with severe stenosis may have a habit of leaning
forward in a stooped position to relieve
pain.
Other symptoms
Other
symptoms may include:
Numbness,
weakness, and cramping in
the legs, feet, or buttocks.
Stiffness in the legs and thighs.
Low back pain.
In severe cases, loss of bladder and bowel
control.
Lumbar
spinal stenosis usually starts gradually and gets worse over a long period of
time. Narrowing of the spinal canal can squeeze and irritate the
nerve roots that branch
out from the spinal cord. This is what causes pain and other symptoms.
The course of spinal stenosis varies-it may stay
the same, get better, or get worse.
Severe disability isn't common. But
when symptoms are very bad, they can keep you from doing your normal daily
activities. They can have a big effect your quality of life. If symptoms are
still severe after you have tried other treatment for a while, surgery may be
considered.
Surgery may be too risky for some older adults who have
other serious health problems.
What Increases Your Risk
The risk of having lumbar spinal stenosis increases if you:
Have an
abnormally narrow spinal canal, which may be inherited or may develop in
curvature of the spine (scoliosis).
Have a
genetic (inherited)
disorder in which the bones of the arms and legs don't grow to normal size and
the vertebrae of the spine don't grow normally (achondroplastic dwarfism).
Have had lower back surgery, which may cause scarring that puts pressure on
the spinal nerves. Progressive spinal stenosis may occur, even after successful
back surgery.
When To Call a Doctor
Call 911 or other emergency services
immediately if a person has signs of damage to the spine after an injury
(such as a car accident, fall, or direct blow to the spine). Signs may include
severe back pain, or weakness, tingling, or numbness in one or both legs.
Call your doctor now if:
You have a new loss
of bowel or bladder control.
Leg pain is accompanied by persistent weakness, tingling, or numbness in
any part of the leg from the buttock to the ankle or foot.
Low back
pain is accompanied by vomiting, fever, or both.
Leg pain, weakness,
numbness that comes and goes (intermittent), or tingling lasts longer than 1
week even though you use home treatment.
Significant back pain either
does not improve or gets worse over 2 weeks.
Watchful waiting
Lumbar
spinal stenosis usually gets worse gradually over months to years. If you have
symptoms that come on suddenly, you may have another serious condition and
should call your doctor.
If you begin to regularly have leg pain when
walking and standing, call your doctor.
Who to see
The following health
professionals can diagnose and treat spinal stenosis:
Lumbar spinal stenosis can usually be
diagnosed based on your history of symptoms, a
physical exam, and
imaging tests-tests that produce various kinds of pictures of your body. These
tests include:
MRI, to check your spinal nerves and
look for disc problems.
Myelogram, to look for narrowing of the
spinal canal or abnormalities of the nerves branching off the canal. This is
rarely used to diagnose spinal stenosis.
Your doctor may try
nonsurgical treatment, such as pain-relieving medicines, exercise, and physical
therapy, for a period of time before ordering imaging tests. If treatment
works, you may not need tests.
Imaging tests can help confirm a
diagnosis or rule out other problems. But even if imaging shows spinal
stenosis, your symptoms may not match the results of the tests. So treatment is
based on what your symptoms are and how much spinal stenosis is impacting your
life, not just on the results of imaging tests.
Treatment Overview
The goals of treatment for spinal stenosis are to relieve pain, numbness,
and weakness in the legs,
to make it easier for you to move around, and to improve your quality of
life.
Treatments include:
Home treatment, such as exercising,
using over-the-counter pain medicines, and losing extra weight.
Prescription medicines to relieve pain.
Physical therapy, to provide education,
instruction, and support for your self-care.
Surgery, although most
cases don't need this treatment.
Prevention
You
can't always prevent changes in your back that may come with aging. But you may
be able to limit spinal stenosis symptoms by keeping your back as healthy as
possible:
Get regular exercise, including flexibility
stretches.
Stay at a healthy weight.
Have good posture.
Don't smoke. Smoking has been linked to back pain and disc problems. It
decreases your bone density and increases your risk of fracture and bone
deterioration. Also, smoking can make it harder for the bone to heal after a
spinal fusion.
Home Treatment
You can take steps to treat lumbar spinal
stenosis symptoms at home:
Learn about stenosis and about
how to relieve symptoms.
Lose
extra weight, which not only can relieve symptoms but also can slow
progression of the stenosis.
Exercise. Aerobic exercise as
well as stretching and strengthening exercises for the lower back and stomach
muscles can relieve symptoms and improve muscle strength, especially when done
4 or 5 times a week. The most helpful aerobic exercises include riding a
stationary bike (with the spine flexed in a forward position) and walking on a
treadmill with an incline.
Restrict activities that make your
symptoms worse. Depending on the severity and location of your stenosis, these
activities might include walking (especially walking downhill) and standing for
a length of time.
Be sure to talk with your doctor before you
start home treatment.
Prevent falls
Pain and
numbness in your legs can increase your risk of losing your balance. Falling
can make symptoms worse. Take steps to lower your risk of falling:
Limit your use of alcohol and sedative medicines, including
flurazepam (Dalmane) and diazepam (such as Valium). They cause drowsiness and
dizziness.
Take medicines
only as directed by your doctor. Review medicines regularly with your primary
care doctor, especially if you have more than one doctor prescribing them.
Medicines like sleeping pills and pain relievers may increase your risk for
falling.
Wear low-heeled shoes that fit
well.
Medications
Taking medicine along with other nonsurgical treatment is often enough to
relieve pain and allow you to do normal daily activities. Be safe with
medicines. Read and follow all instructions on the label.
Medicine choices
Medicines used to
relieve the symptoms of spinal stenosis include:
Acetaminophen, which may relieve pain
but doesn't reduce inflammation. If you can't take NSAIDs, you can try acetaminophen.
Opioid pain
relievers, to relieve severe pain that does not respond to other
medicines. Opioids are usually used only for short periods of time, to help
avoid side effects.
Epidural
steroid injections (ESIs). These are sometimes tried to help leg
pain by reducing inflammation in the nerve root.
Surgery
Surgery is done to relieve pressure on the
nerve roots. This can
help reduce pain, numbness, and weakness in your legs.
Surgery may be
recommended if:
Your pain, numbness, or weakness is so bad that it
gets in the way of normal daily activities and hurts your quality of life.
You are in otherwise good health.
The goal of surgery is to
relieve pain, numbness, or weakness in the legs-not to relieve back pain.
People who have surgery only for back pain are less satisfied with the results
than are those who have surgery for nerve root symptoms and pain in both the
back and legs. Also, numbness, weakness, and pain may return after surgery.
Decompressive laminectomy, which
relieves pressure on the spinal nerve roots, is the most common procedure for
relieving spinal stenosis. This surgery may be done with or without
spinal
fusion.
Other Treatment
Physical therapy is an important
treatment for spinal stenosis. It can help with pain and build muscle strength.
Your physical
therapist may teach you exercises to strengthen your abdominal
(belly) muscles, which will help support your spine. You may also learn
exercises to help maintain flexibility and reduce
inflammation.
Alternative and complementary medicine therapies, such as
acupuncture, are used by
some people to relieve pain from spinal stenosis.
Small metal devices can
be inserted between the bones of the spine, near where the nerve roots leave
the spinal cord. These are called interspinous process devices. The idea is to
create more space between the bones, to take pressure off the nerve roots. This
procedure may be an option for some
people.
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Credits
ByHealthwise Staff Primary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP - Emergency Medicine Adam Husney, MD - Family Medicine E. Gregory Thompson, MD - Internal Medicine Kathleen Romito, MD - Family Medicine Specialist Medical ReviewerKenneth J. Koval, MD - Orthopedic Surgery, Orthopedic Trauma
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