Lumbar Stenosis
 

Periodically, we will be discussing articles of interest to patients and presentations on selected topics. The first topic to be presented is Lumbar Stenosis. The information comes from a Chapter I authored in the Essentials of Physical Medicine and Rehabilitation.

Lumbar stenosis is a very common problem that causes back pain for over 8 to 11 percent of the US population.

It is more common in people over 50 years of age. As the "baby boomers" age, an estimated 2.4 million Americans will be affected.
 

Definition:
 

Spinal stenosis is a condition in which the spinal cord and other nerve structures are compressed due to the tightness of the spinal canal, and the areas where the nerve roots exit the spinal canal; called the intervertebral foramen.

The nerves can be pinched at these areas from herniated discs, lax ligaments or hypertrophy of the facet joints. When the nerves are pinched in the middle of the spinal canal it is called Central Stenosis; when the nerves are pinched in the foramen it is called lateral stenosis.
 

Symptoms:
 

Most people with lumbar stenosis are over 50 and have had chronic low back pain for years. Leg pain is the main complaint in 90% of patients. The pain is usually below the buttocks but may go below the knee. It usually affects both legs.

Most people feel better when sitting. They usually report that pain is brought on by walking and relieved by sitting or bending the back.  In fact, most people can tell exactly how far they can walk before the pain gets bad. Lying on your stomach may also bring on the pain. Patients with lumbar stenosis usually walk stooped over and may have weakness in thigh muscles. Some patients also have numbness in the legs.

 

Functional Limitations:
 

• Walking distance is decreased due to leg pain.
   

• Stiffness of the back and leg muscles develops. The patient's balance and ability to walk will gradually decline.

Tests:

The best test to diagnose lumbar stenosis is an MRI of the spine. Other tests, including EMG / NCV and Doppler studies, may be needed to evaluate for neuropathy and vascular disease.


Treatment:
 

• Conservative treatment with NSAIDs, Gabapentin, and Physical Therapy usually helps.
   

• The therapy consists of special exercises to flex the spine and increase the space where the nerves exit the spine. These exercises are supplemented by mechanical lumbar traction and methods to relax and strengthen the tight back and leg muscles.
   

• Some people may go for lumbar epidural injections for temporary pain relief.
   

• Finally, surgery may be needed to release the pressure on the nerves by decompressive laminectomy and other techniques.
   

• Many people can be helped with conservative treatments

For more information, come in for a copy of the chapter or make an appointment for an evaluation.

We look forward to helping you.

Walter J. Gaudino, MD, MSPT, FAAPM&R