Lumbar spinal stenosis is a narrowing of the spinal canal in the lower back region through which the spinal cord passes. Wherever this opening is narrowed, the surrounding bony structures place pressure on the nervous tissue which travels throughout the lower body and causes sensory changes and muscular strength changes. A variety of discomforting symptoms can occur including numbness, tingling, and pain in the legs or feet, muscle weakness, and lower back pain. Untreated lumbar spinal stenosis can lead to damage to the spinal cord and nerves including severe symptoms such as loss of bladder or bowel control, paralysis of the lower limbs, or sexual dysfunction. At Centers for Neurosurgery, Spine & Orthopedics throughout Northern New Jersey, the medical staff has combined scores of experience providing the most comprehensive, evidence-based care for the successful treatment of lumbar spinal stenosis including both surgical and non-surgical modalities.
Causes of Lumbar Spinal Stenosis
In order to discuss the types of treatment for lumbar spinal stenosis, it is helpful to understand the underlying causes of the narrowing of the spinal canal in which the spinal cord passes. The cause of the spinal stenosis will largely determine the appropriate treatment modality.
Herniated Discs
Between vertebrae in the spinal column are soft joints called discs which act as shock absorbers and help with flexibility. When the exterior of these soft, cartilaginous joints become damaged, a portion of may bulge out of the disc or herniate causing the inner contents to advance into the spinal canal space. If the bulge or herniation is significant, it will press on the spinal cord or the nerve roots as they branch off the spinal cord and travel throughout the body. The pressure on the spinal cord and the nerve roots is the cause of the discomfort.
Spinal Cord Injury due to Dislocation or Vertebral Fractures
Trauma to the spinal column, including sports injuries or auto accidents may lead to fractures or dislocations of the vertebral bone that form the spinal column which creates the space of the spinal canal within. When this occurs, bone fragments or displaced bone may impingement upon the nerves or damage to the spinal cord by reducing the available space within the spinal canal.
Overgrowth of Bone
Damage to the vertebrae due to wear and tear or osteoarthritis may cause bone spurs to develop. These bone spurs may grow into the spinal canal causing a narrowing (a.k.a. spinal stenosis) of the spinal canal which then presses upon the spinal cord. Bone spurs can also grow into the other openings such as the foramina, which allow nerve roots to leave the spinal column. In this instance, the pathology is called foraminal stenosis.
Tumors
When a tumor occurs anywhere in the spinal column or on the spinal cord itself, it has the potential to place excessive pressure on the spinal cord or nerves.
Rheumatoid Arthritis
Swelling and damage to the joints caused by rheumatoid arthritis may occur at any level of the spine including the lumbar spine. This inflammation has the potential to narrow the openings of the spinal canal thereby causing symptoms associated with spinal stenosis.
These are just a few of the potential causes of lumbar spinal stenosis. Other causes include past surgical treatments of the spine, narrowing of the spinal canal present at birth, thickening of the ligaments of the spine, and certain bone diseases.
Treatments for Lumbar Spinal Stenosis
Medications
Pain management through medication is an important part of the treatment for lumbar spinal stenosis. For short-term pain management, medications like Ibuprofen or acetaminophen are sometimes prescribed to provide temporary relief. Anti-seizure medications are sometimes prescribed to decrease pain from damaged nerves. Anti-depressants can provide some relief from long-term, chronic pain. If rheumatoid arthritis is the suspected cause of lumbar spinal stenosis, immunologic medications to reduce the symptoms of this disease may be beneficial. Opioid medications are used to provide short-term relief from the pain associated with lumbar spinal stenosis, and are occasionally considered for long-term pain relief, but must be approached cautiously due to the risk of serious side-effects including dependence, addiction, and overdose.
Epidural or Transforaminal Steroid Injections
When nerve roots and nerves are pinched, swelling may occur which increases the pain associated with lumbar spinal stenosis. Injection of corticosteroids into the space around the impinged nerve or spinal cord can reduce the inflammation, and therefore decrease the pain. While injection of steroids does not treat the narrowing of the spaces, the reduction of swelling in the nerve tissue itself provides relief from pain in some individuals. Repeated steroid injections have the potential to weaken the surrounding bone and connective tissue, so steroid injections are usually provided only a few times per year.
Physical Therapy
Physical activity is important for people with lumbar spinal stenosis to maintain muscle strength. If muscles become weak due to a lack of physical activity, pain can be exacerbated. Physical therapy can inform the patient suffering from lumbar spinal stenosis about the exercises that are the most beneficial to help improve muscle strength and posture to reduce pain. Physical therapy can also inform the patient about the proper use of braces.
Decompression Surgery
Sometimes, surgery is the only option to provide relief from the pain of lumbar spinal stenosis especially when the stenosis is moderate to severe. There are several surgical procedures that are designed to relieve the pressure that is placed on the spinal cord and peripheral nerve roots leaving the spinal column. These surgical options are considered when other treatments have not worked, and a patient is disabled by symptoms or if the spinal stenosis is moderate to severe. Surgical procedures to decompress the area of the spinal column placing pressure on the spinal cord and nerve roots are very effective in relieving symptoms. The best results are obtained by a neurosurgeon or orthopedic spine surgeon from CNSO who have all had extensive experience in performing these procedures.
Contact Us for Help with Lumbar Spinal Stenosis
The multi-specialty team of surgeons, interventional pain management physicians, and rehabilitation professionals at Centers for Neurosurgery, Spine & Orthopedics is uniquely qualified to help with symptoms related to lumbar spinal stenosis. CNSO’s highly specialized team of neurosurgeons, orthopedic fellowship trained spine surgeons, physical medicine and rehabilitation physicians, and physical therapists have formed the most comprehensive surgical and non-surgical treatment plans for the treatment of lumbar spinal stenosis in Northern New Jersey. Please request an appointment to allow CNSO’s highly skilled medical professionals help relieve the pain of lumbar spinal stenosis.
