Lumbar Spinal Stenosis
Lumbar stenosis refers to narrowing within the spinal canal which can be mild, moderate or severe. The classification is based on advanced imaging studies which measure the diameter of the spinal canal. Lumbar stenosis in older adults can be caused from a number of conditions including degenerative changes within the spinal canal, a significant disc herniation, spondylolisthesis, advanced osteoarthritis, ligament hypertrophy, fractures, tumors and cysts.
Lumbar stenosis can present with and without neurogenic claudication, which is leg pain, numbness, fatigue, or weakness with walking. Classically lumbar stenosis with neurogenic claudication presents with the inability to walk through a grocery store. Pushing a shopping cart allows an individual to walk further.
If the stenosis is mild, there may not be any symptoms. For moderate to severe spinal stenosis symptoms may include back pain alone, leg pain, fatigue, weakness or numbness in both legs. If there is presence of bowel or bladder issues such as the inability to urinate, inability to control urine or defecation, it is important to seek evaluation more emergently.
There may be unilateral (one-sided) leg pain similar to sciatica or a greater cause for concern would be myelopathy. Spinal cord compression presents with myelopathy and can include symptoms such as weakness in the legs, inability to walk, loss of control of urinary or bowel, loss of balance and progressive deficits.
A thorough history and physical exam will help to identify neurologic deficits.
Lumbar X-rays will show potential causes of lumbar stenosis such as significant osteoarthritis, tumors, fractures and scoliosis.
Advanced imaging such as a CT or MRI will help identify the true degree of stenosis.
Medications – Oral steroids and Anti-inflammatories may be helpful to reduce inflammation and swelling and relieve irritation of the nerve roots. Neurontin (gabapentin) may be helpful for leg pain and numbness as this reduces nerve excitability. For elderly individuals, the side effects of Neurontin may not be tolerated well.
Physical Therapy: Physical Therapy can help to improve mobility through the hips and knees, strengthen the muscles supporting the spine and reduce strain on the spine.
Injections: Epidural steroid injections can reduce inflammation within the spinal canal especially if leg pain is present to help with pain relief and the ability to walk.
Surgery: If the stenosis is severe with neurologic deficits, it is important to see a spine surgeon for discussion of spinal decompression surgery.