Lumbar spinal stenosis is a narrowing of the spinal canal at the lumbar region (Spinal stenosis, 2018). Ferri (2018) explains that in lumbar stenosis, the spinal nerve roots in the lower back become compressed, and this can place additional pressure onto the spinal cord nerves which can produce symptoms of sciatica involving: tingling, weakness, and/or numbness that radiates from the low back and into the buttocks and legs, especially with activity.
There are not many studies that research the incidence and prevalence of lumbar spinal stenosis. It is estimated that over 200,000 adults have lumbar spinal stenosis and that number is expected to be 64 million in the elderly by the year 2025 (Wu et al., 2017). Most people with spinal stenosis are over the age of 50; however, some individuals have congenital defects with their spinal canal, causing compression on the spinal cord (Spinal stenosis, 2018).
Spinal stenosis can occur due to a variety of reasons. It is most often caused by degenerative disc disease and degenerative arthritis. Other causes of lumbar spinal stenosis include: osteoarthritis of the vertebrae can prompt the formation of bone spurs, Paget’s disease, herniated vertebrae, tumors, spinal trauma, and thickened ligaments (Ferri, 2018). The pathology of lumbar spinal stenosis starts with degeneration of the facet joints, superior and inferior vertebral bodies, and discs. The facets start degenerating causing synovitis that thins the cartilage and loosens the facet capsule, which allows for more spinal movement that causes degeneration and osteophytes (Lee et al., 2015). The formation of the osteophytes narrows the spinal canal.
The pain associated with lumber spinal stenosis can start slow and increase over time. The pain can get so intense that the patient may not be able to walk due to excruciating pain. Neurogenic claudication is the most common symptom associated with lumbar spinal stenosis causing pain in the buttocks, groins, anterior thighs, and down the posterior leg to the feet. Pain will increase with lumbar extension and decrease with lumbar flexion (Lumbar Spinal Stenosis, n.d.). The patient will present with a dull ache in the lower back that worsens with walking.
The diagnosis of lumbar stenosis can be made based on the patient’s physical exam, lumbar spine film sensitivity, ultrasound of the spinal canal, and/or CT scan of the lumbosacral spine (Ferri, 2018; McCance & Huether, 2014).
Patients with lumbar spinal stenosis should initially begin physical therapy, perform recommended back exercises, use lumbar corsets, strengthen their abdominal muscles, and try aquatic exercises (Casazza, 2012). Depending on the severity of spinal cord compression, and associated symptoms such as incontinence, surgery should be considered. Examples of spinal surgeries intended to reduce spinal cord decompression are: laminectomy, laminotomy, and laminoplasty (Ferri, 2018). Medications for symptomatic relief may include: NSAIDS [ibuprofen 800 mg three times daily, naproxen 500 mg twice daily], acetaminophen, epidural glucocorticoid injections [poorly supported for efficacy], tricyclic antidepressants, anti-seizure drugs such as gabapentin or Lyrica, and/or opioids may be helpful in reducing pain caused by lumbar stenosis (Ferri, 2018; Spinal stenosis, 2018; Ebell, 2015). Patients should understand the potential benefits and risks of surgery; patients with spinal stenosis should have a referral to an orthopedic surgeon and potentially to a pain clinic (Ferri, 2018). About one third of patients with lumbar spinal stenosis have coexisting peripheral vascular disease; therefore, vascular health is a major concern with these patients and may require frequent monitoring and medications to help support vascular health.
References:
Casazza, B. (2012). Diagnosis and treatment of acute low back pain. American Family Physician,85(4), 343-350. Retrieved from https://www.aafp.org/afp/2012/0215/p343.html.
Ebell, M. (2015). Spinal stenosis: Physical therapy before surgery. American Family Physician, 92(6), 528-530. Retrieved from https://www.aafp.org/afp/2015/0915/p528a.pdf.
Ferri, F. (2018). Ferri’s clinical advisor 2018. Philadelphia, PA: Elsevier Inc.
Lee, S., Kim, T., Oh, J., Lee, S., & Park., M. (2015). Lumbar stenosis: A recent update by review of literature. Asian Spine Journal, 9(5), 818-828. doi: 10.4184/asj.2015.9.5.818.
McCance, K., & Huether, S. (2014). Pathophysiology: The Biologic Basis for Disease in Adults and Children, 7th Edition. St Louis: Mosby.
Spinal stenosis. (2018). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/spinal-stenosis/symptoms-causes/syc-20352961
Wu, A., Zou, F., Cao, Y., Xia., D., Wei, H., Zhu, B., Chen, D., …. Kawn, K. (2017). Lumbar spinal stenosis: an update on the epidemiology, diagnosis and treatment. AME Medical Journal. Retrieved from http://amj.amegroups.com/article/view/3837/4553.
