Lumbar stenosis: what can be done

Spinal stenosis of the lumbar region (lower back) is a condition that can make normal activities exceedingly painful and difficult to accomplish. In this article, consultant orthopaedic surgeon Mr Raman Kalyan explains how lumbar stenosis occurs and the methods employed to manage the condition and prevent it from worsening.

What is spinal lumbar stenosis?

The spine is a complex, vertical structure in the back that supports much of the body’s weight and keeps us upright whilst allowing a high degree of flexibility and manoeuvrability. The spine is made of 33 stacked bones called vertebrae, which also form the spinal canal. Passing through are the spinal cord and nerves, spanning from the lower back (lumbar region) to the skull. Through openings along the side of the spine, nerves branch out to other parts of the body, transmitting information between the muscles and brain. The spinal vertebrae serve to protect the spinal cord and nerves from impact and possible damage – but also, the vertebrae can cause damage to the spinal cord.

One such manner is stenosis, where the spinal canal narrows enough to put pressure on the spinal cord and nerves. Lumbar stenosis occurs in the five bones near the bottom of the spine, above the coccyx and sacrum. It is most common in people older than 50 years old.

Lumbar stenosis, and other types of stenosis, can develop due to several reasons, such as:

Being born with a naturally narrower spinal canal
Arthritis, where the soft tissues between vertebrae eventually wear away from continual usage over time (osteoarthritis) or due to an autoimmune condition (rheumatoid). In turn, this may trigger extra bone growth called bone spurts, which can extend into the spinal canal
Disc herniation, where shock-absorbing cushions called discs can slip out of position and leak into the canal
Tumours, which are rare but can form inside the spinal canal
Degenerative scoliosis, where the structure of the spine is compromised and vertebrae may shift to the side, narrowing the canal
Thickening ligaments, which normally help hold the vertebrae together but can become stiff and thick over time, taking up space in the spinal canal
Injury to the spine

What are the symptoms of lumbar stenosis?

Spinal stenosis may not have apparent symptoms initially, but if whatever is causing the narrowing progresses without intervention, then as pressure increases, the symptoms will become more noticeable and potent. When affecting the lumbar region, possible symptoms include:

Pain in the legs and lower back
Sciatic pain in the buttocks that shoots down the legs
Numbness, cramping, or tingling in the legs
Difficulty walking due to loss of sensation or weakness in the feet
Sexual dysfunction

With prolonged lumbar stenosis, a serious condition called cauda equina syndrome can develop, which will be accompanied by symptoms such as bowel and bladder incontinence, severe numbness of the legs, and pronounced weakness and pain in the legs that makes it difficult to walk or stand up.

How is lumbar stenosis treated?

Lumbar stenosis treatments begin with conservative, non-surgical options like anti-inflammatory medications, physical therapy to strengthen muscles and improve flexibility, and steroid injections to reduce inflammation and pain. Lifestyle adjustments like regular exercise, maintaining a healthy weight, and stopping smoking can also support spine health and manage symptoms.

If patients find their condition is worsening or not improving with conservative management, then surgery is an option to explore. Surgery for lumbar stenosis is called lumbar decompression, but rather than it being one single procedure, it is a category of procedures that aim to alleviate pain and numbness, which will hopefully, in turn, restore functionality by relieving pressure on the spinal nerves. Included procedures are:

A laminectomy to remove a portion of bone from a vertebra
A discectomy to remove a dysfunctional disc
A lumbar fusion where two or more vertebrae are joined together to stabilise the spine

Lumbar decompression is often conducted with general anaesthesia, so that the patient is not conscious during the procedure and will not experience pain throughout as they are lying face down on the operating bed. The procedure in its entirety can take upwards of an hour.

Upon waking up from the surgery, many patients can report that they immediately feel less pain or have regained normal sensations in their back and legs, and that walking – which they will be encouraged to attempt very soon after – is not as taxing as before the surgery. Patients will stay in the hospital for a few nights in order to recovery and to ensure there are no complications from the procedure. Patients will be given and physical therapy in order to strengthen the muscles and relearn the parameters of movement.

However, patients will be advised to abstain from strenuous activities for at least six weeks, and they may experience residual pain and aches for some months following the procedure.