Definition, Pathophysiology, Incidence, and Prevalence
Spinal stenosis is a narrowing of the spinal canal, lumbar stenosis is the narrowing of the lower back, the lumbar portion (Spinal stenosis, 2018). This spinal canal narrowing can place additional pressure onto the spinal cord nerves which may cause the affected individual pain. Ferri (2018) explains that in lumbar stenosis, the spinal nerve roots in the lower back become compressed and this 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. Spinal stenosis can occur due to a variety of reasons. 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). 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).
Physical Assessment and Examination
Patients presenting with lumbar stenosis experience leg pain with walking, pain relief with sitting, and paresthesia. Pain may radiate down to the patient’s ankles and is associated with numbness, tingling, and weakness; taking a flexed posture reduces symptoms because it increases the available space in the spinal canal (Ferri, 2016). 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).
Treatment and Management Plan
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.
Casazza, B. (2012). Diagnosis and treatment of acute low back pain. American Family Physician,85(4), 343-350. Retrieved February 23, 2018, 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 February 23, 2018, from https://www.aafp.org/afp/2015/0915/p528a.pdf.
Ferri, F. (2018). Ferri’s Clinical Advisor 2018: 5 Books in 1 (Ferri’s Medical Solutions). Philadelphia, PA: Elsevier Inc.
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 February 23, 2018, from https://www.mayoclinic.org/diseases-conditions/spinal-stenosis/symptoms-causes/syc-20352961