Lumbar Stenosis

Signs & symptoms

Frequently, people afflicted with lumbar stenosis have varying degrees of low back pain.

The pain most often occurs during activities and may get worse when walking, standing or leaning backward. Some pain relief may occur when resting, sitting or bending forward.

Other symptoms, which typically occur in the lower back, buttocks, legs and feet, are:

• Cramping
• Numbness
• Stiffness
• Weakness

In severe cases, the condition can impact continence and sexual function.

Diagnosis

Doctors use two kinds of tests to diagnose spinal stenosis. Some of the tests are aimed at making sure there isn't another cause producing the symptoms. Others can indicate that the vertebral narrowing has occurred. After asking you questions about your symptoms, your doctor probably will check your reflexes, gait and other indicators of spinal problems.

Tests include:

• X-ray High-energy radiation is used to take pictures of the spine.
• Magnetic Resonance Imaging (MRI) An MRI provides detailed pictures of the spine that are produced with a powerful magnet linked to a computer.
• Computed Tomography (CT) Scan A CT scan uses a thin X-ray beam that rotates around the spine area. A computer processes data to construct a three-dimensional, cross-sectional image.
• Myelogram This is an X-ray of your spine taken after a special dye has been injected into the spinal column. It can show pressure on the spinal cord or problems with discs or vertebrae.

Treatments

The initial treatment for stenosis is to treat the symptoms rather than the condition itself. These treatments include:

• Medication such as aspirin or ibuprofen to relieve inflammation and pain
• Rest
• Physical therapy
• Posture changes, such as lying with the knees drawn up to the chest or leaning forward while walking, may relieve the pressure on the nerves
• Losing weight
• Corticosteroid injections to reduce inflammation and relieve pain
• A cervical collar

If several months of treatment have not improved the symptoms, and if the stenosis is severe, surgery to widen the spinal canal may be necessary. Because bone continues to deteriorate, additional treatment may be needed several years after even successful surgery. Operations used to treat stenosis include:

• Anterior Cervical Discectomy and Fusion A small incision in the front of the neck is used to access the upper spine. The ruptured or herniated disc is removed and replaced with a small bone plug, which eventually grows to connect the two adjacent vertebrae.
• Cervical Corpectomy Part of the vertebra and discs are removed and replaced with a bone graft or a metal plate and screws to support the spine.
• Decompressive Laminectory The roof of the vertebrae, called the lamina, is surgically removed. The procedure also may include removing part of the disc or fusing the vertebrae (spinal fusion).
• Foramenotomy The area where nerve roots leave the spinal canal, called the foramen, is removed. This procedure can be performed using a minimally invasive approach with an endoscope, an instrument that allows the surgeon to see inside the body through a tiny incision. The surgeon can then use other tiny incisions to perform the surgery, avoiding the discomfort and muscle atrophy associated with the traditional open technique that uses a large incision.
• Laminoplasty The compressive bone in the back of the neck is gently lifted off of the spinal cord creating a new "roof" over the spinal cord and nerve roots. This procedure effectively decompresses the spinal cord over multiple segments without the need for fusion or hardware. It also minimizes the chance of spinal instability or deformity that may result from the traditional laminectomy procedure.
• Laminotomy Only a small portion of the lamina is removed.
• Medial Facetectomy Part of the bone structure in the spinal canal, called the facet, is removed.
• Cervical Disc Replacement A new technology that will be undergoing clinical trials at UCSF Medical Center. Instead of fusing the affected area, the natural disc material is replaced with a metal and plastic prosthesis that maintains or restores the motion segment. This will hopefully prevent degeneration of the next disc level.