Definition of Lumbar Stenosis
Lumbar Stenosis is the irregular narrowing of the canal in the lower back spine or the lumbar part. It usually occurs when a bone or tissue grows and compresses the spinal nerves. This generates numbness, pain and weakness in the buttocks, legs, and feet.
Causes of Lumbar Stenosis
Lumbar Stenosis can be congenital, but it can be developed due to a number of reasons related to degeneration or aging. Here are some of the most common causes of lumbar stenosis:
- Herniated Disk or Slipped Disc
As we age, the disks located in between the vertebrates deteriorate. This causes the soft cushion on the disks to slip and pressure the spinal nerves.
- Bone Spurs
Osteoarthritis can trigger bone spurs (overgrowth of bone), which can develop into the spinal canal and push on the nerve roots of the spine.
- Spinal Injuries
Spinal injuries like bone dislocation or fracture of the vertebrae caused by accidents may damage the material in the spinal canal and press on the spinal cord.
Calcification or the thickening of the ligaments on the spine is an aging factor that may cause nerve compression. The protruded ligaments narrow the spinal canal and squeeze the spinal nerve root.
Tumours can grow inside the spinal cord and occupy the space in the spinal canal.
Symptoms of Lumbar Stenosis
There are several symptoms of lumbar stenosis. This may include:
- Lower back pain
- Pain in the buttocks, feet and legs when walking, leaning backward, or standing straight
- Rigidity in the thighs
- Loss of bladder or bowel control (in some cases)
The symptoms may range from mild to severe. If these symptoms slowly develop over time or come and go, please consult a specialist.
Risk Factors for Lumbar Stenosis
The risk factors of getting lumbar stenosis rises when you:
- Are over 50 years old
- Have an inborn disease that affects the development of bone and muscle
- Have trauma, scoliosis, Spondylolysis and spinal osteoarthritis
- Have a history of spinal injury or lower back surgery
Lumbar Stenosis Diagnosis
Lumbar Stenosis can be diagnosed through symptoms or a physical examination, but doctors may require imaging tests for confirmation:
Some of the usual MRI tests used to identify the dynamic changes on the spine and spinal canal include flexion extension MRIs, spine load-bearing MRIs and upright MRIs.
- CT Scan
Plain CT scans are utilised to detect the skeletal causes of lumbar stenosis. Some doctors utilise CT scan with myelogram. It is a tool that uses radiographic contrast media (dye) that is inserted into the spinal canal’s fluid in order to reveal the changes in the nerve structures.
A back x-ray can detect changes in the spinal structure like bone spurs that can narrow the spinal canal.
Surgical Treatment for Lumbar Stenosis
If symptoms get worse and cannot be cured by pain medicine or other basic remedies, the doctor might suggest surgical treatment for your lumbar stenosis. Here are some of the available surgical treatments for Lumbar Stenosis:
- Laminectomy or Laminotomy
A laminectomy is the most common type of surgical treatment for lumbar stenosis. This releases the compression on the spinal nerve. A minimally-invasive version of this surgical procedure is now used to treat lumbar stenosis. In addition, spinal fusion may also be performed simultaneously with laminectomy. This helps alleviate segments of the spine that were treated with laminectomy. On the other hand, a laminotomy is the micro-decompression or the partial removal of the lamina in order to remove the part of the bone that squeezes the nerve root.
- Facetectomy or Foraminotomy
A facetectomy is commonly a segment of laminectomy. The procedure also removes a part of the spinal structure called facet, which pinches the nerve root in the spinal canal. A foraminotomy is the spinal surgery that expands the passages where the nerves exit the spinal canal. The process includes the removal of the intervertebral foramina that pinches the spinal nerve root. It can also be done with a laminectomy or laminotomy.
- Interspinous Process Decompression
Interspinous Process Decompression, also known as Interspinous Process Distraction, is a minimally invasive surgery that involves an implant inserted between two bony protrusions at the back of the spine called the spinous processes. The device like the X-STOP keeps the spinal canal open and releases the compression. The surgical procedure can be performed under local anaesthetic.
Dr Chua Soo Yong is an Orthopaedic and Specialist Spine Surgeon who is experienced in the management of lumbar stenosis.
Article Courtesy of Dr Chua Soo Yong
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