Lumbar Spinal Stenosis

SPINAL STENOSIS pain doctor dr phillips

Risk Factors

The biggest risk factor for lumbar spinal stenosis is age, because as you age, your spine degradees. Another less common risk factor is osteoporosis as it can lead to compression fracture of the lumbar vertebrae, resulting in lumbar spinal stenosis.

In the majority of situations, the symptoms may improve when the patient is sitting or leaning forward. Generally, painful sensations shoot down the legs with continued walking and diminish with resting. These leg sensations may occasionally mimic sciatica. This specific activity-related symptom is usually referred to as pseudoclaudication (or neurogenic claudication) since it mimics the true claudication of poor circulation from the narrowed blood vessels of peripheral vascular disease. When you stand and bend backwards, itcan make the symptoms worse, as bending forwards increases the space in the spinal canal and vertebral foramina, while bending backwards decreases this space.

Low back pain originating due to lumbar spinal stenosis can be a congenital origin,  an acquired condition, or are a combination of both.  The most common cause is degenerative changes is due to aging of the spine.  A combination of disc degeneration, bulging disc and facet and ligamentum flavum hypertrophy, in the posterior column, bone spurs cause concentric narrowing leading to central spinal stenosis.  A combination of a bulging disc, and or a laterally protruding disc and facet degenerative changes can also cause neuroforaminal stenosis.

The degree of spinal stenosis is rated as mild, moderate, or severe in the central canal or the neural foramen.  Lumbar spinal stenosis due to degenerative changes is the most common cause of spine surgery in the elderly population over the age of 65.  Symptoms may include low back pain, pain radiating into the lower extremities, more better weakness and or numbness or tingling sensation, neurogenic  claudication (pain, discomfort, numbness and tingling, or weakness in the muscles of the lower extremity success exacerbated by walking, and relieved by a flexed posture or rest.).  The presentation of pain that is placed on the overriding factor is central canal stenosis or neural foraminal stenosis.  Significant neuroforaminal stenosis can cause radicular pain in a specific dermatomal distribution, or pain radiating into the lower extremities presenting like sciatica pain.

Diagnoses for Lumbar Spinal Stenosis:

A lumbar spine MRI is a good diagnostic study.  It can detail the degenerative changes causing varying degrees of central and neural foraminal stenosis.  This can be correlated with the presenting history and physical examination.  

Treatment:

Conservative treatment is the first recommended treatment option for most cases of pain due to lumbar spinal stenosis.

1 Rest

2 Activity modification

   -The goal is to avoid aggravation of pain e.g. pain due to neurogenic claudication.   

   – Avoid lifting heavy objects.

   – Avoid activities long walks, running, standing for prolonged periods.

3 Exercise and physical therapy

4 Application of heat and or ice

5 Medications (NSAIDS, Tylenol, muscle relaxants, medications for nerve pain e.g. gabapentin or lyrica opioids can be considered on a case-by-case basis if other conservative measures and non-opiate medications have failed.)

6 Lumbar epidural steroid injection

7 Decompressive surgery

8 Decompressive lumbar spine bracing

In order to be treated for your Lumbar Spinal Stenosis, please email or call Innovative Pain Solutions today at 407-284-1993.

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