Marc M. Soloman, MD
The lower (lumbar) spine is made up of five vertebrae (bones) bodies in the lower back and is the physical center of the body. These bones are the largest and strongest since they support and carry the weight of the muscles and bones above it. A normal, healthy spine has lumbar vertebrae which stack on top of one another in a centered alignment.
However, when one ages, the spinal column changes, often resulting in a degeneration of the vertebrae, discs, muscles, and connective tissues (ligaments). These changes narrow the open spaces of the lower back and may lead to a condition called lumbar spinal stenosis.
Stenosis is derived from the Greek word meaning “to choke”. Therefore, when spinal nerves in the lower back are “choked”, lumbar spinal stenosis occurs. If the narrowing is substantial, it compresses the spine putting additional pressure on the spinal cord and the nerves that travel through it.
Like other joints in the body, arthritis may occur in the spine as part of the normal aging process. The most common cause of lumbar spinal stenosis are degenerative conditions such as osteoarthritis, disc disease, and spondylolisthesis. Osteoarthritis occurs when there is a loss of the cartilage between the bones and joints, formation of bone spurs, and loss of disc height. Further degeneration of the lumbar discs can lead to spondylolisthesis which is when vertebra slip on to one another.
Although less common than degenerative arthritis, lumbar spinal stenosis can also be caused by other conditions that reduce the space for the nerves in the spinal canal such as tumors, infection, or bone disorders.
Symptoms of lumbar stenosis generally develop slowly over time (most patients are over the age of fifty) and may come and go. Besides lower back pain, one may also have leg and buttocks pain, tingling, a weakness in those areas and numbness or a decreased sensation in the legs. As the symptoms worsen, the condition may become debilitating.
Some patients may find cramping in the legs when standing for long periods or even when walking. The pain usually subsides when resting, sitting, or bending forward. Each person will find the severity and duration of the condition different which will dictate the approach for treatment.
A physical examination alone does not yield a definitive diagnosis. An imaging study must be done by an MRI scan, or a CT scan with myelogram (an x-ray dye in the spinal sack fluid) to determine which of the three types of stenosis is identified.
Treatments vary per individual and the conservative (non-surgical) ones may include anti-inflammatory medications, physical therapy, exercise, and/or epidural injections. Of course, surgery will be discussed when all other nonsurgical methods have failed. A surgical procedure is most reliable for the relief of leg pain and not necessarily back pain. A surgery may include a lumbar decompression with or without a lumbar fusion.
Marc M. Soloman, MD is a board-certified anesthesiologist with extensive training in Pain Management, and always stays current with all new and up to date information through many educational meetings throughout the year. He is practicing pain management at Valley Pain Consultants – West Valley, 6780 W. Thunderbird Road, Suite A105, Peoria, AZ 85381. Please visit www.ValleyPain.org for other locations near you. To schedule an appointment, call 480-605-0573.