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What is Lumbar Spinal Stenosis?

Lumbar spinal stenosis can be defined as any narrowing of the lumbar spinal canal, nerve root canals, and/or intervertebral foramina that may encroach, compress, or impinge on the nerve roots of the low back. This condition can become a potentially painful and disabling condition in affected individuals.

Two types

Lumbar Spinal Stenosis can manifest itself in a couple of different ways:

Lateral stenosis - narrowing within the intervertebral foramina and/or nerve root canal, causing compression of the spinal nerve that exit the spine

Central stenosis - narrowing that occurs within the central spinal canal, causing compression around the spinal cord

How does it happen?

Lumbar spinal stenosis is most often an acquired condition stemming from degenerative changes (such as degenerative disc disease), spondylolisthesis (anterior vertebral slippage), fractures, and scarring from surgical procedures.

What happens internally?

The most common change is compression (a decrease in disc height), and is often accompanied by facet joint arthrosis, bulging of ligamentum flavum, posterior/lateral bulging of the intervertebral disc.

How common?

Lumbar spinal stenosis is very common, especially in older adults. It is the most common reason for undergoing lumbar spine surgery in individuals over 65 years of age.

What are the symptoms?

Sufferers of lumbar spinal stenosis can expect a variety of symptoms, including: pain and/or numbness in one or both legs; possible diminished or decreased lower extremity reflexes and strength or sensation deficits; difficulty standing and walking without leaning forward (e.g. - on a shopping cart); relief with sitting and forward bending.

People may occasionally experience something called neurogenic claudication. This manifests as poorly localized pain, tingling, and cramping of one or both legs; worse with walking and better with sitting.

How is the diagnosis confirmed?

A clinical diagnosis for lumbar spinal stenosis can be made with the help of an MRI, CT scan, or through Myelography

Are X-RAY's helpful too?

X-RAY's can show degenerative changes such as bone spurs, narrowing of the foramina, and approximation of the vertebrae. However, X-RAY's are limited by their inability to image the central spinal canal and the soft tissue changes that often contribute to spinal stenosis.

What are surgical options?

The most common surgical option for lumbar spinal stenosis is a decompression laminectomy (where portions of the vertebral arch are removed to reduce compression of the spinal nerves). Sometimes a fusion is performed with or without instrumentation. This is usually the option when there is evidence of accompanying spondylolisthesis (slippage of one vertebra on another).

Other options?

Epidural steroids can provide short-duration benefits and relief for lumbar spinal stenosis. Most research shows that this generally does not last beyond a couple weeks.

Best physical therapy treatment?

The best physical therapy treatments for lumbar spinal stenosis include flexion based exercises and general conditioning activities are encouraged (such as bicycle, aquatic exercise, or walking as tolerated). An experienced physical therapist can help you identify and address strength and flexibility deficits. Low back and hip joint mobilization, along with stretching of the hips, and low back with mechanical or manual traction (decompression) can also be very helpful and effective to alleviate pain, improve mobility, and restore normal function.

Joseph Marangella, DPT, OCS, CCCE

Alliance Physical Therapy

Source: "Orthopedic Physical Therapy Secrets"

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