Lumbar spinal stenosis
The spinal column is narrowed in the case of spinal stenosis. This causes impingement of one or more nerve roots. The impinged nerves can cause pain in the legs whilst walking. This is also referred to as neurogenic claudication.
Stenosis means narrowing. Lumbar stenosis occurs primarily in people over the age of 50 years.
Description of the condition
The lumbar spinal column is formed by the vertebrae of the lower back. The vertebrae are stacked on top of each other and form a long vertical canal. A large bundle of nerves runs through this canal. In the case of canal stenosis of the lumbar spinal column, the spinal canal is narrowed. This can result in impingement of the nerve roots in the canal. This results in symptoms in the area that is innervated by the nerve root.
Cause and origin
A person can be born with a narrow spinal canal, or it can develop gradually. Reasons for narrowing are for example; as a result of arthrosis, a prolapsed intervertebral disc or a thickening or folding of a ligament structure in the spinal canal (the ligamentum flavum). Compressed discs, tumours, infections and fractured vertebrae can also result in narrowing of the spinal canal.
Signs & symptoms
Often the patient will have had back problems for years. The back pain usually decreases significantly, followed by the typical symptoms in the legs.
- Pain and fatigue in the legs (heavy or lame sensation).
- The symptoms occur after walking or standing for some time.
- Irritation, pins and needles, numbness and loss of strength.
- In some cases, bladder problems can also occur.
- The symptoms occur when the back is arched. Lying on the stomach or the back makes the symptoms worse.
- Sitting with a rounded back and bending over usually provides immediate relief. Cycling is generally not a problem.
The diagnosis is made based on the symptoms and the physical examination. X-rays, a CT scan and an MRI can be helpful in the imaging of the narrowing and in determining the exact location.
If the narrowing is caused by ageing or wear-and-tear of the spinal column, often conservative treatment is the most sensible option initially. The patient will be advised to avoid activities that provoke the pain, such as long walks and long periods of standing. Advice on posture can help the patient to reduce the hollowing of the lower back, which reduces the symptoms. Leaning on a shopping trolley or walker also helps, as this causes a slight rounding of the back. In the long term the symptoms usually disappear without treatment.
Other treatment options include wearing a corset or brace, treatment with medication, epidural corticosteroid injections and traction. People who do not smoke have a greater chance of successful conservative treatment.
Surgical treatment will be considered if the conservative approach does not produce results. This relieves compression of the affected nerve root(s) by creating more space in the spinal canal.
The exercise programme for lumbar canal stenosis is aimed at reducing the symptoms.
Cleland, J.A. & Koppenhaver, S. (2011). Netter's orthopaedic clinical examination: an evidence-based approach. 2nd ed. Philadelphia: Saunders Elsevier.
Nugteren, K. van & Winkel, D. (2008). Onderzoek en behandeling van spieraandoeningen en kuitpijn. Houten: Bohn Stafleu van Loghum.
Nugteren, K. van & Winkel, D. (2006). Onderzoek en behandeling van lage rugklachten. Houten: Bohn Stafleu van Loghum.