Spinal Stenosis

Lumbar spinal stenosis refers to a narrowing, crowding, or compression of spinal cord or spinal nerves in the low back. It is most common reason for back pain. The results from the age of 65. Stenosis can be either congenital or acquired but acquired is by far the most common. Most often the stenosis is the results of either a buildup of age-related change of the spine including degenerative disc disease and facet arthropathy. In some cases the stenosis is created suddenly by a massive disc herniation.

The hallmark symptom of clinically significant lumbar spinal stenosis is neurogenic claudication. This refers to pain, weakness, or numbness in the low back, buttocks and legs which is brought on by walking. Typically these patients walk test by leaning forward. Patients will often admit that they could not go shopping without leaning on a shopping cart hands the “shopping cart sign” which is associated with this condition.

Treatment

The treatment depends primarily on the degree of stenosis (mild, moderate, or severe) as well as the functional limitation of the patient. Interestingly some patients may have what is considered significant stenosis on their MRI but may not be particularly bothered when they walk. However, patients with severe stenosis and significant limitation in their ambulation are often considered candidates for surgery.

Usually before surgery is performed or in cases where patient is trying to delay surgery, an epidural steroid injection is an option. Epidural steroid injections may provide weeks or months of benefit which may allow the patient to delay surgery. However, in the setting of severe stenosis and failure of epidural steroid injections, a surgical evaluation is recommended. The goal of surgery is to decompress the affected area of the spine and often results in improvement in ambulation.