>>
 Pain that radiates from the back and buttocks into one or both legs and occurs mainly
with standing or walking distances may be a sign of lumbar canal stenosis. Lumbar canal
stenosis refers to narrowing of the hole or canal where spinal nerve roots travel before they leave
the spine and travel to the legs. Patients often report the need to stop walking and sit down in
order to relieve the pain in their back and legs before starting to walk again. Some patients
report a sensation of weakness or “heaviness” in their legs as well. Because bending forward at
the waist gives slightly more room for the nerves, they often bend forward on a shopping cart
when walking in a store to alleviate the pain. These symptoms can worsen such that people
avoid activities that involve walking or standing for long periods, seriously affecting their quality
of life.
Lumbar canal stenosis is related to degenerative changes in the spine. The spinal nerve
root compression is caused by lumbar disc bulging or herniation as well as ligament and bony
overgrowth. Forward or backward slippage of the lumbar bones, called spondylolisthesis, can
also contribute to nerve compression. While X-rays and CT scans are helpful, Lumbar spine
MRI is the best test for diagnosing lumbar canal stenosis as well as its severity.
Treatment of lumbar canal stenosis ranges from conservative to surgical options
depending on the severity of the symptoms and degree of stenosis. Physical therapy and pain
medications such as non-steroidal antiflammatories are an initial option. Epidural steroid
injections into the spinal canal can also be tried. While these measures do not change the
narrowing of the spinal canal, they can provide significant temporary relief. Surgical measures
include minimally invasive as well as more open decompression of the nerves via laminectomy.
Some patients are candidates for the minimally invasive X-STOP procedure in which a titanium
implant is placed between the bony protrusions in the lower back called spinous processes. The
intended effect is to keep the spinal canal open when standing upright or extending the lumbar
spine.
Laminectomy or laminotomy surgery involves removing some portion of the “roof” or
lamina of the spine, allowing access to the nerves. Surgery is generally reserved for patients that
have severe lumbar canal stenosis confirmed by MRI and who have not achieved significant
relief of their pain with conservative or steroid injection options. When done in this setting,
laminectomy surgery has excellent success rates for patients with spinal stenosis.
|
