Lumbar Spinal Stenosis

Causes of lumbar spinal stenosis

Lumbar stenosis is typically caused by the day-to-day wear and tear on the spine from degenerative conditions such as bone spurs and bulging or herniated discs.  

• Bone spurs — bone overgrowth in the lumbar spinal canal can occur as the wear and tear on the spine increases.
• Herniated discs — if the discs between the vertebrae crack and leak some of the inner material, the material could press on the spinal cord and nerves.
• Thickened ligaments — ligaments that hold the bones together can thicken over time and bulge into the spinal canal.
• Injuries to the spine — accidents that cause vertebrae fractures can damage the spinal canal and put pressure on the nerves in the lower back
• Tumors in the spinal cord — tumors can grow in or around the spinal cord, putting pressure on the nerves and causing symptoms.
• Congenital lumbar stenosis — some patients are born with congenital lumbar stenosis. These patients are more likely to develop symptoms from degenerative conditions such as bone spurs later in life. 

Risk factors for lumbar spinal stenosis

There are a variety of factors that increase your likelihood of developing lumbar spinal stenosis including:

• Age — lumbar spinal stenosis is most common in people over 50 years old.
• Genetics — if you have a family history of lumbar spinal stenosis, you are more likely to develop the condition as well.
• Trauma — if you had spinal trauma from a previous accident, you are at greater risk of developing lumbar spinal stenosis.
• Congenital spinal deformity — if you were born with a spinal deformity such as scoliosis, you are at greater risk for developing lumbar spinal stenosis later in life.

Symptoms of lumbar spinal stenosis

Some people with lumbar spinal stenosis do not experience any symptoms. If symptoms do arise, the most common symptoms are:

• Pain in the legs, lower back or buttocks
• Difficulty standing and/or walking long distances
• Relief when sitting 
• Heaviness in legs
• In severe cases, motor function may be impaired significantly, and you may experience bowel or bladder incontinence

The pain can radiate down the back sides or front of the legs, can be constant or can feel like cramping. In most cases, the pain is amplified as you increase your activity level.

Diagnosis for lumbar spinal stenosis

Lumbar spinal stenosis can be diagnosed by a primary care or spine specialist. During a physical exam, your doctor will evaluate your symptoms, take a full medical history and order diagnostic imaging tests. Imaging tests may include:

• X-ray
• MRI
• Myelogram 

Treatment for lumbar spinal stenosis

Many patients will find relief from nonsurgical treatments for lumbar spinal stenosis. Your Mercy Health physician team will work with you to determine the most appropriate treatment protocol for your case. Unless you have severe lumbar spinal stenosis, you will be started with nonsurgical treatment options.

Nonsurgical treatment options for lumbar spinal stenosis include:

• Physical therapy — exercises outlined in a physical therapy plan can help relieve pressure on the nerve roots.
• Medications — your doctor may prescribe a non-steroidal anti-inflammatory medication such as a pain reliever, antidepressants, anti-seizure medications and opioids (sparingly).
• Epidural corticosteroid injections or nerve root injections — an injection can help relieve pain and reduce swelling associated with the compressed nerve.

If nonsurgical options are not effective or if your symptoms are worsening, some patients may need surgical intervention to treat lumbar stenosis. 

Surgical options to treat lumbar spinal stenosis include:

Anterior lumbar interbody fusion (ALIF)
Anterior lumbar interbody fusion surgery is surgical treatment option for degenerative lumbar spinal stenosis. ALIF is a commonly used spinal fusion procedure that provides more rigid fixation due to the combined anterior (from the front) and posterior (from the back) approaches.

Extreme lateral interbody fusion (XLIF)
The XLIF procedure is a minimally invasive spinal fusion approach where the spinal surgeon approaches the lumbar intervertebral disc area using a side approach instead of from the front or back. The benefits of having XLIF are minimal tissue damage and blood loss, smaller incisions and shorter recovery period after surgery.

Lumbar laminectomy with spinal fusion
During a lumbar laminectomy with spinal fusion procedure, your surgeon will remove the affected lamina (bone covering the back of the vertebrae) in the lumbar spine to ease the pressure on the nerves. After the lamina is removed, your surgeon will fuse the adjoining vertebrae with a bone graft or metal hardware.

Lumbar laminectomy without spinal fusion
During a lumbar laminectomy without spinal fusion, your surgeon will remove the affected lamina in the lumbar spine but will not fuse the vertebrae back together after the procedure.

Laminotomy
During a laminotomy procedure, your surgeon will remove a small portion of the lamina to relieve the pressure in a specific spot.

Transforaminal lumbar interbody fusion (TLIF)
A transforaminal lumbar interbody fusion is a spinal fusion surgery that uses a posterior approach (through the back) to fuse the anterior and posterior columns of the spine.