The back bone or Spinal or Vertebral Column provides the skeletal enclosure that houses the delicate spinal cord that stretches from the end of the brain stem down to the bottom or lumbar region of the spinal column. The Vertebral Column is the main support to the human body that allows a person to sit, stand, bend or twist. The vertebral column is divided into three regions – the neck or cervical region, the thoracic or mid-spine region and the lumbar or lower back.
Disorders of the spine can be either intrinsic or extrinsic to the spinal cord. One such disorder of the Spinal column is the Lumbar Spine Stenosis. Stenosis is a Greek word that means choking, so when there is intrinsic growth of tissue or the bone(s), in the lumbar region, it narrows the spinal canal, consequently choking the spinal nerves. This causes pain or numbness in the lower back and legs.
Causes
As we age certain changes occur within the human body. Some such changes (as listed below) occur to cause Lumbar stenosis or lower back pain.
- Bone spurs or bony outgrowths occur due to arthritis. These spurs push on the nerves that branch out of the spinal cord, causing the pain and / or numbness
- The ligaments between each vertebra thicken, thereby narrowing the passage in the spinal canal
- Between each vertebra is a disc or cushion that prevents rubbing of one vertebra against the other. When these discs push inwards, into the spinal canal, it can cause lumbar stenosis
Symptoms
- Cramping, numbness, pain or weakness in the lower limbs or buttocks. The symptoms may increase when walking, leaning back or standing straight but reduces when leaning forward while sitting down
- Pain in the lower back
- Legs and thighs may experience stiffness
- In extremely advanced stages, it can cause loss of bowel and bladder control
Diagnosis and Tests
Lumbar stenosis is diagnosed by the doctor who will conduct a physical exam after enquiring about the medical history of the patient. Further tests such as X-rays, MRI scan and / or a CT scan may be prescribed.
Whom should You Consult?
The following Specialist Doctors will provide the best diagnosis and advice on the right treatment.
- An Orthopedic or Orthopedic Surgeon
- A Neurologist or Neuro-surgeon
Treatment Options
- For mild pain, numbness or cramping, exercise and medications may be prescribed.
- Medications will include pain relievers
- Physiotherapy will be recommended
- A cortisone injection may be delivered to alleviate the pain
- Generally surgery is the last resort and only in cases where the pain is severe and the quality of life has been affected
Surgery
The goal of performing a surgical procedure is to relieve the pressure on the nerves and alleviate the pain / numbness in the lower back / legs and to improve the quality of life of the person under care.
The most common procedure that is performed to relieve back pain, numbness in the back and legs or weakness, is called Decompressive Laminectomy, which is performed with or without fusion of the vertebrae.