Stenosis
means narrowing. In lumbar spinal stenosis, the spinal canal, which contains the
spinal cord and nerve roots, narrows and pinches the spinal cord and nerves. The
result is low back pain as well as pain possibly weakness and numbness in the
legs. The bladder and bowel can also be affected is some cases.
There
are many potential causes for spinal stenosis, including: Aging. As we get
older, the ligaments of the spine can thicken. Bone spurs may develop and press
into the spinal canal. (See picture) The cushioning disks between the vertebrae
may begin to deteriorate and cause the disc to flatten (spondylosis). The joints
(facet joints) were the vertebra attach to each other also may begin to break
down. Finally, just the wear and tear of a lifetime of hard work may contribute
to this condition.
Symptoms of spinal stenosis may
include pain and difficulty when walking which can lead to falls. Numbness, tingling and weakness in the legs are also common.
This condition, undiagnosed, can in some cases lead to the complete
inability to walk if left untreated.
Generally, conservative treatment is helpful in the early phase of this condition, but as the stenosis persists and worsens over time many people require surgical intervention. Usually a MRI or CTS is required to diagnosis this condition and occasionally a Myelogram is done. Myelograms are done as an outpatient and require a small amount of X-ray dye to be placed by a spinal tap. A Myelogram can determine the degree of stenosis by the amount of myelographic dye that flows to the spinal fluid that surrounds the spinal nerves.
The surgery most often done to treat spinal stenosis is called a lumbar laminectomy. Lumbar laminectomy involves relieving the pressure on the spinal cord and nerves. The surgery is somewhat more invasive that a microdiscectomy because generally the area of the incision is larger. Depending on the levels of the spine, which require decompression, an incision is made in the lumbar area and the lamina or outer bone covering of the vertebra is exposed. Then using specialized instruments and often the operating room microscope the lamina is removed and any compression from bone or ligaments is also removed. The areas of the spinal where the nerve roots exits to the legs are also explored and pressure relieved.
Generally, a patient after surgery has leg pain relief, but may experience incisional pain. Pain medication and occasionally a short course of physical therapy is required post-op. Most patients after one month are back to most activities and can begin to enjoy life again.
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© 2008 Tri-State Neurosurgical Associates - UPMC
Last Updated: January 1, 2008