ABOUT
Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal, which compresses the nerves traveling through the lumbar spine and into the legs. Diagnosis of lumbar spinal stenosis is largely concluded from a complete clinical history and physical examination, which should begin with a thorough assessment of the back; as the exam progresses, the following common symptoms should serve as red flags and promote follow-up:
- Dull to severe aching pain in the lower back or buttocks that worsens with walking or other activity
- Pain that radiates into one or both thighs and legs
- Relief of symptoms by sitting or lying down, and/or by bending forward at the waist
- Evidence of an increasingly sedentary lifestyle in an effort to control pain
- Loss of motor function in legs, bowel or bladder (rare)
If any of the above symptoms are observed, it is highly recommended that confirmation be obtained through MRI, myelogram or CT myelogram as well as consultation with a spine specialist.
The characteristic syndrome associated with lumbar stenosis is signaled by lower back pain, numbness and tingling in the lower extremities which worsens with prolonged standing or walking.
TREATMENT
The compression that occurs with LSS is caused by an overgrowth of bone. Patients with moderate stenosis have been shown to improve after receiving only conservative treatment. Conservative treatments include non-steroidal anti-inflammatory drugs (NSAIDs), epidural steroid injections, physical therapy, lumbar bracing and bed rest. Non-surgical treatments such as these may be attempted to manage the condition initially in patients with mild symptoms of short duration. However, after roughly one year of conservative treatment, patients who still have moderate pain will benefit more from surgery than from continuing their conservative treatment plan. And even though pain and discomfort associated with this condition may be relieved through conservative treatments, the only option that will exclusively open the lumbar canal and ultimately correct the problem is surgery.
If conservative treatments do fail, surgical options should absolutely be explored.