Lumbar spinal stenosis is a condition where the spaces in the spinal canal of the lower back have become obstructed or narrowed leading to pressure being placed on the spinal nerves and the spinal cord. Compression of blood vessels, and problems with the intervertebral discs, spinal ligaments, and other important tissues and structures can also be both the cause and effect of spinal stenosis. Lumbar spinal stenosis is an extremely common condition suffered by many with symptoms ranging from mild, occasional aching in the back or the buttocks, to acute shooting pain down into the feet, numbness, weakness, mobility problems, bowel and bladder incontinence, and paralysis.
Lumbar Spinal Stenosis Surgery
lumbar spinal stenosis treatment largely depends on the degree of narrowing in the spinal canal and the cause of that pathology. Stenosis may be due to a disc herniation, rupture, or bulging disc, in which case traction, endoscopic discectomy, or open traditional discectomy may be indicated. Developments in both surgical technique and hardware mean that patients may also be able to have an artificial disc replacement in order to preserve movement in the spine. Traditionally, the removal of an intervertebral disc has meant that the spine needed extra support through fusion surgery, which increases the risk of complication over more minimally invasive procedures. Fusion surgery in itself may, however, be indicated, as this can restore the correct alignment of the spine and prevent spinal curvature or slippage from putting pressure on the spinal nerves or cord.
Foraminotomy for Lumbar Spinal Stenosis
If stenosis is a result of osteophyte growth (bone spurs) in the foramina where the spinal nerve roots exit the spine then a foraminotomy is the most likely treatment. Some people may have congenitally narrow foramina making lumbar spinal stenosis more likely. A foraminotomy involves the use of a burr, or small surgical saw, to shave off the outer edge of the foramen and decompress the spinal nerves. This can have the effect of almost instantly relieving the symptoms of lumbar spinal stenosis, although some residual numbness, weakness, and pain is usual as the nerve heals. For those with a longer history of nerve compression the pain may never subside as permanent damage has occurred.
X-Stop for Lumbar Spinal Stenosis
Lumbar spinal stenosis and sciatica can be treated in some cases through a procedure performed under a local anesthetic where a device called the X-Stop is inserted between the spinous processes at the back of the spine. This device restores intervertebral height and can give patients the same type of relief from nerve compression when standing that they may feel when bending forward. The back surgery is minimally invasive and can effectively remove or postpone the need for more invasive procedures such as discectomy, laminectomy or spinal fusion.
Laminectomy, Laminotomy, and Laminoplasty for Spine Decompression
Laminectomy, laminotomy, and laminoplasty are all procedures aiming at decompressing the back and relieving pressure on the spinal nerves and spinal cord. If disc herniation or osteophyte growth is reducing space in the spinal canal then the excision of a portion of the thick bony structure (lamina) covering the back of the spine can effectively decompress the back. A laminotomy is where a small window is cut into the back bone for decompression, a laminectomy involves the removal of a large portion of the back bone and often requires spinal fusion afterwards, and a laminoplasty creates a hinged effect in the back bone in order to increase the space without compromising spinal stability. The degree of spinal stenosis and the presence of narrowing at one or more levels will determine which of these procedures is the most appropriate.
Conservative and Alternative Treatments for Lumbar Spinal Stenosis
Of course, back surgery is not the only option for treating lumbar spinal stenosis, with many patients finding a significant degree of relief when using conservative treatments or alternative therapies. NSAIDs are frequently used to manage pain and inflammation, although they do have some serious potential side effects particularly when used long-term. Other analgesics may help, as can muscle relaxants, and alternative remedies to reduce inflammation and pain.
Some patients have selective nerve root blocks as both part of the treatment for their lumbar stenosis and part of the diagnosis itself. These injections use a steroid medication to reduce inflammation around the nerve at the level thought to be causing the pain. A local anaesthetic is usually injected at the same time and this can provide instant relief from the symptoms of lumbar stenosis. If the pain does not dissipate then it is likely that a different vertebral level is responsible for the symptoms of back pain and a further nerve root block is indicated to establish the origin of the pain.
Physical Therapy Treatment
Physical therapy may help patients avoid activities which exacerbate pain and the strengthening of the core muscles can often help correct postural problems which may be responsible for the stenosis in the first place. Back exercises for sciatica, and specific exercises to help with disc herniation or disc bulging can reduce pain and discomfort and ensure that the muscles of the spine do not become tight or atrophy through disuse. Inversion tables and traction devices can help to relax and realign the spine, but the latter may cause painful muscle spasms for some. Ice packs can help take down inflammation, and heat packs may relieve tired muscles – although inappropriate use of cryotherapy or thermotherapy may exacerbate a condition. Never apply heat to an acute injury, for example.
Many patients also find that the Alexander Technique can help them address postural issues related to their lumbar stenosis, and that the use of ergonomic furniture and work devices also helps. Engaging in regular, appropriate, physical activity is also beneficial and should be discussed with a qualified professional who is aware of the patient’s medical history. Low impact exercise is usually recommended, such as swimming, walking, or marching on a mini trampoline. Patients often effectively treat their lumbar spinal stenosis using acupuncture and acupressure as this can affect the way the body perceives pain signals. Chiropractic techniques and orthopaedic manipulation may be of help for some patients, but those with more progressed stenosis may find that this treatment is inadvisable as it presents certain risks.
With a huge number of people suffering from lumbar spinal stenosis, and stenosis of the neck and mid-back, it is hardly surprising that so many treatment options are available. Whichever course of action a sufferer takes, it is usually a case of simple trial and error to work out the therapy most effective for each individual.