Lower back pain, weakness or numbness in buttocks or legs, pins and needles sensation are all possible symptoms of a condition called lumbar spinal stenosis. Spinal stenosis itself refers to any narrowing of the spinal canal and the reduction in size of the openings in the bony vertebral canals through which nerves can exit and branch out. Lumbar spinal stenosis specifically refers to when this phenomenon occurs in the lower back.
There are many safe and effective treatments for lumbar stenosis. Patients who suspect they have lumbar stenosis should seek out the services of an expert physician for accurate diagnosis and the most appropriate treatments. The doctors at the Ainsworth Institute of Pain Management are experts in diagnosing and treating lumbar stenosis and can offer you treatment options not available anywhere else in New York City.
What is Lumbar Spinal Stenosis?
As mentioned above, lumbar stenosis refers to the narrowing of the cavity in your lower spine which contains the spinal cord and spinal nerves. The spinal cord extends from your brain all the way down the spine to the bottom, the spinal nerves branch off from the spinal cord, exit the spine through the openings called the foramina, and extend through he rest of the body regulating the function of organs and bodily processes.
The spinal nerves and spinal cord relay sensory information to the brain. All the sensations we feel, pleasant, unpleasant, or neutral are detected through the spinal nerves and passed up the spinal cord to the brain. In the other direction, this nerve highway carries messages from the brain to govern voluntary and involuntary motor functions.
With lumbar spinal stenosis, the spinal cord and spinal nerves become compressed, either within the spinal canal or nerve passageways. This results in abnormal signals getting sent to and from the brain, or not getting through at all. Patients then experience the pain, numbness or disorientation associated with lumbar stenosis. It affects men and women equally and is most commonly seen in people over 50, and people who work in labor-intensive fields.
Types of Lumbar Stenosis
The spinal canal is the space in the vertebral column of your upper and middle back through which your spinal cord passes. The foramina (nerve passageways) are the spaces in the lower back through which your nerve roots extend to the rest of the body. A variety of diverse causes including age and heredity can cause these areas to narrow, leading to everything from back and neck pain, to difficulty balancing and walking.
There are two types of lumbar stenosis. If the spinal canal is narrowed, the disorder is also termed lumbar central stenosis. If nerve passageways are narrowed, it is called lumbar foraminal stenosis. When either condition develops, the spinal cord and/or nerves are compressed. Sometimes, patients have both types of lumbar stenosis.
Stenosis can occur at any point along the spine, but cervical (neck) and lumbar stenosis are the most prevalent. Symptoms can vary somewhat based on the level of the spine where the stenosis occurs. The symptoms associated with lumbar spinal stenosis are:
Low back pain; not always severe
Pain, weakness, or numbness in the buttocks or legs
Difficulty and pain when walking, standing, or bending backwards.
Pain relieved by resting or leaning forward
Burning, tingling, and pins and needles sensations
In severe cases, bladder and bowel problems
Although rare, severe cases can cause loss of function or paraplegia
Lumbar stenosis can be caused by a diverse group of factors.
The Aging Process
Degeneration of the spine
Development of bone spurs
Herniated intervertebral discs
Compression fractures, common in osteoporosis
Arthritis that can enlarge and inflame joints
Patient born with small spinal canal
Deformities of the vertebrae
Injury to the back
How is Lumbar Stenosis Diagnosed?
If you believe you are suffering from lumbar stenosis you should consult a qualified physician. Typically, stenosis starts gradually and worsens over time. Stenosis will not improve or go away on its own. The procedure for diagnosing stenosis may include these steps:
Medical history – Your doctor inquires about symptoms, their severity, what treatments you have already tried and the results.
Physical examination – The physician will examine you for limitations of movement, balance problems, and pain. The physician will test your reflexes at the extremities and evaluate muscle weakness, loss of sensation, and signs of neurological injury.
Diagnostic tests – Generally, doctors start with plain x-rays, which help rule out other problems, such as a tumor or infection. CT scans and MRIs may be performed to obtain more detail about your spinal problem, such as evidence of a herniated disc or osteophytes (bony growths). Sometimes, myelography is performed. Myelography involves injecting contrast dye into the spinal column to visually enhance areas where the spinal cord or nerve roots may be pinched.
Many different nonsurgical treatments help relieve symptoms. These include:
Medications – A short-term course of medication can be highly effective at relieving pain and muscle spasm. This may include medications such as an anti-inflammatory to reduce swelling and pain, muscle relaxants to calm spasm, and occasionally, narcotic painkillers to alleviate severe pain.
Physical therapy – May include gentle massage, stretching, therapeutic exercise, bracing, or traction to decrease pain and increase function. As part of physical therapy, patients with lumbar stenosis will be educated in proper posture and body mechanics.
Cold/heat therapy – This is typically performed as part of physical therapy and is especially useful during the first 24 to 48 hours of pain onset.
Alternative therapy – There are a variety of treatments that are aimed at allowing the body to heal itself. They include treatments like acupuncture.
Interventional Pain Management Treatments
Interventional techniques can be a faster and more definitive method of pain relief for lumbar stenosis. These treatments are useful in the presence of severe pain that has failed conservative medical treatment and/or medication.
Lumbar Epidural Steroid Injection – This procedure is considered a very effective treatment for back pain. It is basically the same treatment a woman will receive during childbirth. Under fluoroscopic guidance, your physician will place a small needle into the epidural space and inject a small amount of medication to eliminate the pain.
Spinal Cord Stimulation (SCS) – When the inflammation in and around the affected nerves is too great for an epidural injection, SCS is an excellent and effective treatment option that can eliminate the pain without surgery. In SCS, an electrical pulse is delivered directly to the spine, blocking certain neuron fibers’ access to the brain and consequently the brain’s ability to sense the previously perceived pain.
Microdiscectomy – This involves removing part of a herniated or bulging disc that is compressing the spinal cord and contributing to the stenosis. It is a minimally invasive procedure, with little to no recovery time.
If nonsurgical measures are not successful, surgery may be recommended.
There are different surgical techniques to treat lumbar stenosis. The goal of surgery is to decompress, or take pressure off the spinal cord and nerve roots. Decompression involves removing or trimming whatever is causing compression. The presence of neurological deficit, cauda equina syndrome (i.e. loss of bowel and/or bladder control), or other problems, may require a surgical intervention.
Schedule an Appointment Today
The doctors at the Ainsworth Institute of Pain Management specialize in treating lumbar spinal stenosis. Dramatic improvements in pain and quality of life are a single phone call away. Schedule an appointment today with one of our board certified pain management experts to discuss what options for treatment may best suit your needs.