by Dr. Marianne Kinsler, Medically Reviewed by Dr. C.H. Weaver M.D. 5/2022
The word stenosis is of Greek origin and means "narrowing". In a person with lumbar spinal stenosis, the narrowing refers to their spinal nerves being choked or constricted. The constriction applies pressure on the nerves or spinal cord and the muscles.
Lumbar spinal stenosis typically develops in the lower back, but it can affect any part of the spine. Here are several of the reasons why a person can develop spinal stenosis, including:
- Degenerative disk disorders
- Rheumatoid arthritis
- Spinal tumor
- Spinal injury
- Previous spinal surgery
- Spondylolisthesis (with cauda equina compression)
- Ankylosing spondylitis
- Paget's disease of bone
Anyone can develop lumbar spinal stenosis, but it is most common among men and women over 50 years old. People who have scoliosis and any other spinal condition may also be susceptible to lumbar spinal stenosis. Additionally, those with an inborn narrow spinal canal may be at great risk for spinal stenosis.
Lumbar Spinal Stenosis Types
Below are the different types of lumbar spinal stenosis:
- Foraminal Stenosis
- Lateral Recess Stenosis
- Central Spinal Stenosis
Foraminal stenosis commonly develops in the lumbar and cervical spine. It is the most common type of spinal stenosis and involves the foramen, which refers to the bony spaces on each of the lower spine's sides.
Lateral recess stenosis develops when the area within the spinal canal's rear sides has narrowed down.
Like foraminal stenosis, central canal stenosis develops in the lumbar and cervical regions, areas that are subjected to a lot of movements.
How Will You Know If You Have Lumbar Spinal Stenosis?
Several signs or symptoms can help determine if you have lumbar spinal stenosis:
- Sciatica-like pain: If there is a burning feeling or an ache that starts in the buttocks area and then spreads down your leg, your spinal nerves are pressured or constricted.
As the burning pain progresses, it becomes difficult to move around freely and comfortably because of the pain in your foot.
Lumbar Spinal Stenosis: Symptoms And Surgical Treatment Options
If you constantly suffer from leg or lower back pain, or sciatica, you may have lumbar spinal stenosis.
Acute Anterior Uveitis (AAU) & Chronic Low Back Pain
Acute Anterior Uveitis (AAU) and Chronic low back pain (CBP) EQUAL Ankylosing Spondylitis (AS)
- Foot drop or weakness in your legs: This typically happens if the lumbar spinal stenosis is already at a critical level. Your legs (one or both) will become weak. It becomes particularly difficult if there is a foot drop or if you have difficulty lifting your foot off the ground because it feels like something is dragging or slapping it on the ground as you walk.
- Tingling or numbness of the legs and/or buttocks: Aside from the burning pain, you may also experience tingling or numbness in your legs and buttocks.
- Acute cauda equina: This condition is quite rare, so if you experience this, your best option is to seek immediate medical treatment or, in some cases, surgery. Cauda equina syndrome is a condition where you no longer have control of your bladder and/or bowel, and there is numbness in your private area. Your legs may also lose strength, which means you won't be able to walk.
Other symptoms include:
- Lower back pain that comes and goes
- Pain that gets worse when you walk downhill (or simply walk) and stand for long periods
- Pain that slowly disappears as you bend forward slightly, lean, sit down, or walk uphill
Are There Surgical Treatments For Lumbar Spinal Stenosis?
Lumbar spinal stenosis is diagnosed through imaging tests, such as MRI and CT scans; and lumbar spine x-rays. Other options include a muscle activity electrical test known as EMG, myelogram, and bone scan.
After diagnosis, treatment will begin, which often includes a combination of medicine and physical therapy. Surgical treatment may also be carried out if the situation calls for it.
What are the surgical treatments available to you? Your doctor or physician will inform you if you need lumbar spinal stenosis surgery. This normally happens in severe cases. You'll need surgery if:
- You can no longer tolerate the symptoms
- The symptoms have affected your daily activities and quality of life
- You're having difficulties maintaining your balance, and walking has become a challenge
- Pressure on your spinal cord is causing you intolerable pain
- You no longer have bladder or bowel control
Your doctor will then give you a rundown of the surgical options that are applicable to your case. The different types of lumbar spinal stenosis surgery are:
- Foraminotomy - surgically opens or enlarges the bony exit by removing tissue or bone to open up more space for the nerve roots to exit; can be performed alone or with laminectomy or laminotomy
- Laminotomy - intended to relieve nerve roots pressure by creating an opening in the lamina or bone; the procedure removes a small portion of the lamina; also known as partial laminectomy
- Laminectomy - the most common lumbar spinal stenosis surgical procedure, which involves the entire lamina to make space for the nerves and spinal cord; some bone spurs and ligaments are also often removed
- Spinal fusion - this surgical procedure is ideal for patients who have developed spinal instability (resulting from progressed arthritis); the surgery intends to fuse or join (permanently) two vertebrae; the first step is a laminectomy procedure so the lamina can be removed and used for creating a bridge connecting the two vertebrae; this helps encourage new bone growth; recovery often takes a minimum of six months and a maximum one year
Lumbar spinal stenosis surgery, like other surgical procedures, comes with risks, such as the bone not healing, metal plates or screws not working or holding, nerve injury, non-relief of symptoms, and the need for more surgery. As such, it is vital to discuss your options first with your doctor. It is also important to follow surgery preparation requirements, such as regular exercise (if approved by your doctor) and changing your diet to a healthier one.
Apart from spinal fusion, lumbar spinal stenosis surgery recovery will typically last three months. However, this can change depending on the circumstances of your case and your rehabilitation progress.
While there is no permanent cure for lumbar spinal stenosis, you can manage your symptoms by regularly exercising and maintaining your ideal body weight, maintaining proper posture, not smoking, and committing to a lifestyle change that includes eating a healthy and balanced diet. Following your doctor's professional advice, both non-surgical and surgical; is also essential.
About the author
Dr. Mohamed M. Abdulhamid is a neurosurgeon and the Founding Director and CEO of Royal Spine Surgery in Phoenix, Arizona. He is certified in total cervical disc replacement, or artificial disc replacement, in minimally invasive Coflex® procedure, in minimally invasive discectomy and in intraoperative navigation and image-guided surgery. In addition to traveling for work, Dr. Abdulhamid enjoys traveling with his family. He also enjoys photography and he uses his camera to capture the beautiful landscape surrounding him locally and while traveling.