Conditions & Treatments

Degenerative Lumbar Spinal Stenosis: A Quiet Thief of Independence

Degenerative lumbar spinal stenosis is a very common condition, and while it can affect people of various ages, it is much more common in people over 55. The term stenosis refers to a narrowing or tightening. In a patient with carotid stenosis, for example, a person gets a narrowing of the carotid arteries leading to a decrease in blood flow to the brain. In a patient with spinal stenosis, the neural canal that transmits the nerves is narrowed, usually by bony spurs and degenerative, protruding discs. Figure 1 is an MRI showing the cross section of a normal sized nerve canal (red arrow). The white, oval shaped area is the normal size of the neural canal that tramsmits the nerves to the legs. Figure 2 shows an MRI cross section of a patients with severe spinal stenosis. The large, oval shaped nerve canal has been severely narrowed and all the nerves are crowded into a very small area (red arrow). If the stenosis occurs in the low back, this can cause back and leg pain, or heaviness and cramping in the legs. Patients with lumbar spinal stenosis may have trouble walking. They can find that when they walk they begin to have worsening symptoms of back pain and/or a pain, heaviness, tightness or cramping in the legs and they find themselves leaning forward when they walk. This is because when the patient with spinal stenosis is leaned forward, they are able to open up their spinal canal somewhat, thereby taking some of the pressure off of the pinched nerves in their back, enabling them to walk a little farther. You will sometimes see these people when they are at the store leaned over on a cart doing their shopping.

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Treatment options for lumbar spinal stenosis are based upon the severity of the condition. An MRI scan is a radiologic study that can be used to quantify the degree of spinal stenosis a patient has. Treatment options for mild cases often involve the use of medications and/or physical therapy. For more severe cases, epidural steroid injections can be used. Epidural steroid injections involve placing a cortisone like substance into the spinal canal. These shots can improve the symptoms of spinal stenosis for months at a time. In the most severe cases, when a patient has either failed more conservative treatments or if the patient is felt to have a real or impending neurologic deficit, surgery is considered. While surgery is not taken lightly, there have been vast developments of more successful and less invasive surgical alternatives than there were years ago. These newer surgical options have led to less down time and a lower complication rate while improving surgical outcome and patient satisfaction. The X-Stop Implant is one such example (Figures 3 & 4). In this surgical technique, an implant is inserted between the spinous processes of two adjacent vertebrae and distracted, thus indirectly opening up the nerve canal. The nerve canal is not opened up and so there is no scar tissue formed in the neural canal. There is no fusion and so full motion is preserved. For a single level it is a 20-30 minute outpatient procedure which can be performed under general or local anesthetic. Recovery is days to weeks, rather than weeks to months with traditional surgeries for spinal stenosis.

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In summary, spinal stenosis is a condition which can gradually limit the ability to walk and cause the patient to lean far forward when they walk, progressively stealing their independence and making them at high risk for falls. Treatment options are available which can usually relieve the symptoms of spinal stenosis and are based in part on the severity of the patient’s condition. Most patients respond well to non-operative care. If surgery is required, there are multiple newer and less invasive options which can improve outcome and reduce recovery time. If your doctor tells you that you have spinal stenosis, all treatment options should be discussed and an educated plan should be made between you and your physician to improve your pain, function, and quality of life. The majority of patients with spinal stenosis can be treated successfully and go on to achieve a much more comfortable and active quality of life.

Treatments for Lumbar Spinal Stenosis (LSS)

Dr Hellman is a spinal surgeon practicing in Tifton, Georgia at Georgia Sports Medicine & Orthopedic Clinic. He is double board certified in both the fields of orthopedic surgery and spinal surgery. Dr. Hellman is a member of the American Academy of Orthopedic Surgeons; a member and has been a faculty presenter for the North American Spine Society; and is a member of the International Spine Intervention Society. His special interests include the use of less invasive alternatives in neck and back surgery; motion sparing techniques in spinal surgery such as the artificial disc and the “x-stop”; and the treatment of complex spinal deformities such as scoliosis.