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Lumbar Canal Stenosis

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A woman doctor describes the anatomy of the spine to her colleagues.

Lumbar Canal Stenosis: An Overview

The Normal Spinal Canal
The spinal canal is a tube-like space protected by the vertebral bones, extending from the base of the neck to the lower back. The spinal cord and spinal nerves travel through this space from the brain to reach their destination in the upper and lower limbs. The typical spinal canal has adequate free space around the spinal cord and nerves filled with Cerebrospinal Fluid (CSF). This free space is essential for the normal functioning of the spinal cord and nerves.
Lumbar Canal Stenosis
Spinal Stenosis results from inadequate space inside the backbone, which eventually puts pressure on the delicate spinal cord and nerves. Lumbar Canal Stenosis refers explicitly to narrowing the spinal canal in the lower back or the lumbar area. However, it can also occur in other parts of the spinal canal. Although spinal Stenosis can affect anyone, it's predominantly observed in individuals over 50.
Spinal Stenosis is commonly caused by long-term spinal wear and tear due to arthritis, eventually resulting in ‘progressive’ nerve root compression and symptoms. Although some people undergo surgery for spinal Stenosis, it may not cure their arthritic pain.

At Spine 360, spine specialist hospital in Bangalore, we recommend non-surgical treatments, medication, and therapy to rectify this spinal condition. Kindly consult our orthopaedic experts to diagnose and treat lumbar canal stenosis.

Lumbar Canal Stenosis: Risk Factors

Several factors contribute to an increased risk of developing lumbar spinal Stenosis including, such as:
Age
More than 50 years – age related changes such as osteoarthritis of facet joint, bony spurs, thickening of flavum (soft tissue tissue covering the canal and nerves).
Congenital narrowed canal
Congenital narrowed canal is developmental defect (2.6% - 4.7) which causes narrowing of abnormalities or disorders in postnatal development.

Spinal Stenosis: Causes, Symptoms & Warnings

Causes

  • Connective tissues - ligaments (ligamentum flavum ) get thicker
  • Facet hypertrophy (over growth of joints in the spine)
  • Spondylolisthesis – Slippage of one vertebrae over another with displacement of disc (pseudo disc bulge) compressing the nerves
  • Degenerative scoliosis – deformed curvature of spine as a consequence of degeneration of spine
  • Previous lumbar surgery (post-surgical scaring)
  • Infection – Uncommon cause
An image shows a spine model with a red highlight indicating the area of pain.
The image of a person with low back pain.

Symptoms

  • Pain in the buttocks, hips and legs or sciatica - Less pain with leaning forward or sitting or lying, pain aggravates on bending backwards (unilateral or bilateral)
  • Difficulty in walking – Neurogenic claudication – Cramping in the calf with walking, requiring frequent multiple short rests to walk a distance
  • Pain in the legs at rest
  • Numbness or tingling in legs
  • Loss of sensation in the feet
  • Weakness in Legs
  • Weakness in the foot that causes the foot to slap down when walking
  • Sexual dysfunction

Spinal Stenosis: Tests & Diagnosis

At Spine 360, our specialists will conduct a physical examination to evaluate your symptoms and your medical history before recommending the most appropriate diagnostic tests like:
Image of a person undergoing an MRI scan.
MRI is a noninvasive imaging method of choice to justify the presence of anatomic narrowing of the spinal canal or the presence of nerve root impingement.
An X-ray image of the neck.
X-rays to identify any spur growths that may be compressing your spinal nerves or narrowing the spinal canal.
Image of CT Scan machine @Spine360.
CT scan taken after injecting a contrast dye

Non -Surgical Treatment Recommendations for Spinal Stenosis

Medication
Analgesic, NSAIDS, Anticonvulsants (Pregabalin , Gabapentin ) can give relief when there is mild canal narrowing. In moderate to severe canal narrowing it might not be beneficial or may provide only temporary relief.
Physiotherapy

It is important to do regular physiotherapy to keep the back and joints flexible, though physiotherapy itself doesn’t help in reducing the nerve compression. Physiotherapy should be done in consultation with a qualified physiotherapist and should not be done in presence of severe pain.

Epidural steroid injection

Good short-term relief in terms of leg pain (2-6 months)

Lumbar braces or belt/corset
Minimal relief in terms of walking distance – But no sustained results
A doctor is analyzing a spine x-ray.

Lumbar Canal Stenosis: Surgical Treatments at Spine360

A spine expert performs a lumbar canal stenosis procedure.

A patient may be considered a candidate for surgery if:

  • Back and leg pain limits normal activity or impairs quality of life
  • Progressive neurological deficits develop (leg weakness, foot drop, numbness in the limb)
  • Loss of normal bowel and/or bladder functions
  • Difficulty standing or walking
  • Failed medical therapy

The primary goal of surgery is to create space for the nerve to pass through and relieve compression on the nerve and can in the form of decompression and fusion which is performed in a minimal invasive fashion.

Decompression
Laminectomy and Foraminotomy – removal part of bone, soft tissue and ligaments – for patients with predominant leg pain without instability. This can be done minimally invasively, using either a tube or an endoscope.
Spinal fusion

In case of dominant back pain coupled with leg pain and spine instability. Here an artificial graft/ cage is placed in between the two vertebral bones and stabilised with screws and rod to achieve fusion between the two adjacent bones.

Know more about the Surgery for Lumbar Canal Stenosis.

  • In both cases you are made to walk on next day morning
  • Immediate relief of leg pain is felt
  • Minimal operative site pain and back pain as a result of surgery is expected with numbness in leg at times
  • Benefits of surgery appear to last for many years (long term relief)

In small percentage of cases there is risk of adjacent segment disease (upper or lower level), but with timely physiotherapy and lifestyle modification risk can be reduced

A happy doctor with a stethoscope.

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