What are the other Names for this Condition? (Also known as/Synonyms)

• LSS (Lumbar Spinal Stenosis)
• Lumbar Spinal Canal Stenosis
• Narrow Lumbar Spinal Canal

What is Lumbar Spinal Stenosis? (Definition/Background Information)

• Lumbar Spinal Stenosis (LSS) is a degenerative disorder that causes an abnormal narrowing of the spinal canal
• It is usually caused by wear and tear of the articular cartilage that covers the bony surface of joints within the lumbar region of the spine. The condition is mostly associated with advancing age
• The signs and symptoms of Lumbar Spinal Stenosis may include lower back pain, loss of bladder/bowel function, and functional impairment. Some of the complications can include paralysis, weakness or fatigue, and complete loss of muscle strength
• Nonsurgical and surgical methods may be used to treat Lumbar Spinal Stenosis. The prognosis of Lumbar Spinal Stenosis may vary, but is good with early diagnosis and treatment
• The disorder can be difficult to prevent due to the risk factors increasing with age. However, exercising regularly and reducing abnormal stress on the back can slow progression of Lumbar Spinal Stenosis

Depending on when it occurs, Lumbar Spinal Stenosis can be classified into the following types:

• Degenerative Lumbar Spinal Stenosis (more common condition) affecting elderly individuals typically
• Congenital Lumbar Spinal Stenosis affecting children at or following birth

The three major types of Lumbar Spinal Stenosis are lateral stenosis, central stenosis, and foraminal stenosis.

• Lateral stenosis: Lateral stenosis is the most common type of spinal stenosis, which results when a nerve root within the spinal canal is compressed. This may be caused by a bulging disc, herniated disc, or bone protrusion
• Central stenosis: Central stenosis is the narrowing of the central spinal canal, which is the area of the spinal canal that surrounds the spinal cord and cauda equina.
• Foraminal stenosis: Foraminal stenosis is a type of stenosis that primary affects the foramen (any opening or structure that allows muscles, nerves, arteries, or veins to connect one part of the body to another). This will occur when nerve roots within the spinal canal compress and are trapped by bone spurs within the foramen

Who gets Lumbar Spinal Stenosis? (Age and Sex Distribution)

• Individuals of all ages, race, ethnic groups, and gender can develop Lumbar Spinal Stenosis.
• A high percentage of individuals who develop this degenerative, debilitating, and progressive disorder involve middle-aged to elderly individuals
• Lumbar Spinal Stenosis is more prevalent in women than men
• If younger individuals develop this disorder, it is usually due to a genetic abnormality that affects the entire body

What are the Risk Factors for Lumbar Spinal Stenosis? (Predisposing Factors)

Common risk factors associated with Lumbar Spinal Stenosis include:

• Advancing age
• Studies have indicated that Lumbar Spinal Stenosis has a genetic prevalence. Children who have an immediate family member or relative with a history of Lumbar Spinal Stenosis have an increased risk of also developing the disorder
• A medical condition characterized by the body’s inability to produce enough necessary thyroid hormone (hypothyroidism)
• A disorder caused by high level of secretion of the hormone cortisol by a tumor of the adrenal cortex (Cushing’s syndrome)
• A hormonal disorder that develops within the pituitary gland, which is caused by the overproduction of growth hormone (acromegaly)
• A congenital inflammatory disorder that causes chronic inflammation in the spine and sacroiliac joint (a pelvic joint). Over time, the affected joints of the vertebrae within the spine fuse together (ankylosing spondylitis)

What are the Causes of Lumbar Spinal Stenosis? (Etiology)

Common causes associated with Lumbar Spinal Stenosis include:

• Past traumatic spinal injuries
• Children who are born with an abnormally narrow spinal canal (congenital spinal stenosis)
• Abnormal growths on the spine, such as a spinal tumor
• Ruptured or prolapsed lumbar disc
• A rare bone disorder called Paget’s disease of bone, which is characterized by abnormal growth and deformity of the bones (Paget’s disease)
• Thickened ligaments within the spinal canal
• Degeneration of the spinal canal, which causes the space between the vertebra to narrow (degenerative osteoarthritis)

What are the Signs and Symptoms of Lumbar Spinal Stenosis?

Common signs and symptoms associated with Lumbar Spinal Stenosis include:

• Excessive pain in the lower back
• Numbness, weakness, or a tingling sensation within the leg, foot, arm or hand
• Loss of bladder/bowel function
• Cramping within the legs when standing for a prolonged period of time
• Functional impairment (clumsiness, poor fine motor skills and coordination)

How is Lumbar Spinal Stenosis Diagnosed?

Lumbar Spinal Stenosis is a disorder that may be difficult to diagnosis due to the signs and symptoms often resembling age-related disorders. Diagnostic tools that aid in identifying the exact cause of the disorder include:

• Complete physical examination of the back with evaluation of medical history
• Spinal X-ray: X-rays are useful in ruling out other possible causes that have related symptoms
• Magnetic resonance imaging (MRI) scan of the spine: The most common diagnostic test used to identify Lumbar Spinal Stenosis. An MRI is a more detailed scan that uses radio waves and a magnetic field that generates thorough images of interior bones and soft tissues. An MRI can usually identify if the spinal cord is compressed
• Computerized Tomography (CT) scan: A CT scan takes a series of X-ray images from several different angles. These images are then merged to create cross-sectional images of bones and soft tissues with the body. This allows a healthcare provider to examine the spinal column and surrounding structures.
• CT myelogram: A CT myelogram is a specialized diagnostic imaging procedure that injects a special dye into the surrounding areas of the spinal cord. X-rays or CT scan images are then taken to help a healthcare provider detect any spinal abnormalities

What are the possible Complications of Lumbar Spinal Stenosis?

Complications associated with Lumbar Spinal Stenosis include:

• Loss of bladder/bowel function
• Paralysis
• Chronic pain within the back and neck
• Feeling tired
• Loss of muscle strength (paraplegia)
• Urinary incontinence
• Impotence

How is Lumbar Spinal Stenosis Treated?

Methods for treating Lumbar Spinal Stenosis depend on the severity of the signs and symptoms. The purpose of treatment is to relieve pain and stiffness, help resume regular/daily activities as soon as possible, and prevent permanent damage to the spinal cord and surrounding nerves.

• Wearing a specialized back brace or can help rest the back muscles while decreasing the range of motion.  This helps to reduce irritating the nerves in the back
• Non-steroidal anti-inflammatory oral medications, such as ibuprofen, naproxen, and ketoprofen may be used to treat Lumbar Spinal Stenosis. These medications can help decrease pain and swelling
• Individuals who experience muscle spasms may be prescribed certain muscle relaxant medications, such as diazepam or cyclobenzaprine, which may relieve pain within the back.
• Antidepressant medication such as Imipramine, which belong to tricyclic antidepressants can help to relax muscles and reduces bladder spasms
• Anti-seizure drugs, such as gabapentin and pregabalin are commonly used to decrease pain that is the direct result of damaged nerves
• Corticosteroid injections into the epidural space help in temporary relieving symptoms, such as pain, and in improving range of motion. It is important to note that corticosteroid injections only give temporary relief and prolonged episodes of such injection may injure the joints in the long run
• Physical therapy exercises that include strengthening and improving flexibility within the neck can help reduce discomfort

Surgical treatment for Lumbar Spinal Stenosis:

• Lumbar laminectomy: Lumbar laminectomy is a surgical procedure intended to relieve pressure on the spinal cord and/or nerves by removing the lamina in order to widen the spinal cord. During a lumbar laminectomy procedure, the lamina (the small section of the bony roof in the spine) is removed to create additional space for the surrounding nerves within the spinal canal. A bone graft material then fills the empty space and two or more vertebrae of the lumbar spine are fused together to create stability. However, this procedure may also be performed without a lumbar spinal fusion, or the healthcare provider may elect to perform a microlumbar discectomy (removing of part the lumbar disc).
• Lumbar laminoplasty: Lumbar laminoplasty is a surgical procedure that is performed to relieve pressure on the spinal cord and/or nerves by moving the lamina to the side in order to widen the spinal cord. During a lumbar laminoplasty procedure, the lamina (the small section of the bony roof in the spine) is moved in order to expand the spinal canal. A bone graft material then fills the empty space and two or more vertebrae of the lumbar spine are fused together to create stability. However, this procedure may also be performed without a lumbar spinal fusion.

How can Lumbar Spinal Stenosis be Prevented?

Lumbar Spinal Stenosis is a progressive condition that is extremely difficult to prevent due to risk factors increasing with age. However, following certain guidelines that may help slow the progression of Lumbar Spinal Stenosis include:

• Exercise regularly
• Limit activities that may place abnormal stress on the back
• Begin any new physical activity slowly with a thorough and complete warm-up. Individuals are advised to add low-impact activities to their exercise program to avoid repetitiveness.
• Individuals who participate in any high-impact sports, such as football, should wear appropriate safety equipment to help decrease the risk of developing Lumbar Spinal Stenosis
• Maintaining correct posture when standing, sitting or working on the computer, may help relieve unwanted stress on the spine
• Maintain a healthy body weight, which can help to reduce unwanted stress on the spine
• Individuals who maintain a healthy lifestyle may decrease the likelihood of developing Lumbar Spinal Stenosis or at least slowing down the progression of the condition

What is the Prognosis of Lumbar Spinal Stenosis? (Outcomes/Resolutions)

• The long term prognosis with Lumbar Spinal Stenosis depends on the severity of the degenerative disorder an individual develops
• If the cause of Lumbar Spinal Stenosis is detected early, and aggressive treatment is provided, the quality of life of the individual can be substantially improved. This also helps avoid any serious complications from arising in the neck
• Some individuals who develop LSS can live productive lives. To others this disorder may become debilitating and experience a gradual degeneration of the bones and cartilage within the back at some point during their lifetime

Additional and Relevant Useful Information for Lumbar Spinal Stenosis:

The following article links will help you better understand different surgical treatment methods of Lumbar Spinal Stenosis:

http://www.dovemed.com/common-procedures/procedures-surgical/lumbar-laminectomy-and-rhizolysis/

https://www.dovemed.com/common-procedures/procedures-surgical/microlumbar-discectomy-mld/