Lumbar spinal stenosis

Lumbar spinal stenosis is a narrowing of the spinal canal in the lower back, known as the lumbar area.

The spine is made up of bones called vertebrae. The spinal cord runs through an opening in the bones called the spinal canal. Sometimes bones and tissue grow into this canal and press on the spinal cord and/or the nerves that branch out from it. This causes pain, numbness, or weakness in the back, buttocks, legs, and feet.

The most common symptom of lumbar spinal stenosis is leg pain that happens when you walk or stand but feels better when you sit. You feel pain in your legs because the nerve roots that pass through the lower spine extend to the legs. Symptoms occur when these nerve roots get squeezed.

Other symptoms may include:

• Numbness, weakness, and cramping in the legs, feet, or buttocks.
• Stiffness in the legs and thighs.
• Low back pain.
• In severe cases, loss of bladder and bowel control.

Many people, especially those older than age 50, have some narrowing of the spinal canal but don't have symptoms. If there are symptoms, they may be very bad at times and not so bad at other times.

The doctor can usually diagnose lumbar spinal stenosis by:

• Asking about your history of symptoms.
• Doing a physical exam.
• Using imaging tests. These take different kinds of pictures of your body. Tests may include:
  • MRI, to check your spinal nerves and look for disc problems.
  • CT scan, to check your bones and joints.
  • X-rays, to check for arthritis or injuries to the bones of the spine (vertebrae).
  • Bone scan, to rule out cancer and other bone diseases.
  • Electromyogram and nerve conduction tests, to see if other problems may be causing or adding to your symptoms.

Your doctor may try nonsurgical treatment, such as pain-relieving medicines, exercise, and physical therapy, for a period of time before ordering imaging tests. If treatment works, you may not need tests.

Treatments for lumbar spinal stenosis include:

Medicines to help manage pain.

Medicines include NSAIDs and acetaminophen.

Physical therapy.

This includes stretching and strength exercises that may reduce pain and other symptoms.

Steroid shots (injections).

If other nonsurgical treatments haven't worked, these shots are sometimes tried to help leg pain by reducing inflammation in the nerve root. They may work for some people. But they may work for only a short time.

Surgery to relieve pressure on the nerve roots.

Unless the symptoms are disabling, most people with lumbar spinal stenosis don't need surgery. Surgery is most often used to relieve pain, numbness, or weakness in the legs.

Interspinous process devices.

These small devices can be put between the bones of the spine to take pressure off the nerve roots. This may be an option for some people.

Exercise and changing the way you do your activities may also help you feel better.

You can take steps to treat lumbar spinal stenosis symptoms at home. Be sure to talk with your doctor before you start home treatment.

Steps you can try include:

Changing the way you do your activities.

This means trying other ways of doing your activities—ways that don't cause pain or make other symptoms worse. For example, this might mean using a tall stool for tasks that you would normally do standing up. Or you could use a shopping cart or a wheeled walker so that you're leaning forward a little when you walk.

Taking medicines to manage pain.

Medicines include nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. NSAIDs, such as ibuprofen and naproxen, seem to be the best over-the-counter pain medicines. But if you can't take NSAIDs, you can try acetaminophen. Be safe with medicines. Read and follow all instructions on the label.

Exercising.

You can try walking on a treadmill with a slight incline. Or you could ride a stationary bike. In both of these types of exercise, your spine tilts forward a little as you work out. So they might be more comfortable for you than other exercises. Your doctor or physical therapist may also teach you exercises to improve strength and flexibility.

Limiting activities that make your symptoms worse.

Depending on the severity and location of your stenosis, these activities might include walking (especially walking downhill) and standing for a length of time.

Taking steps to lower your risk of falling.

These steps include trying to remove household hazards, such as throw rugs, and clearing cluttered walkways.