If you experience greater lower back pain after standing or walking for longer periods of time, you may have lumbar spinal stenosis. Stenosis, from the Greek word for “choking,” refers to a narrowing of the spinal canal. It can cause pain, in the back and the arms and legs. If you suffer from lumbar spinal stenosis, there are a few specific treatment options that can help you reduce your pain and get back to your life. In this post, we’ll be tapping into expert knowledge to cover the symptoms of spinal stenosis and treatment options that could work for you.
What is lumbar spinal stenosis?
Spinal stenosis refers to a narrowing of the spine canal anywhere along your back. Lumbar spinal stenosis refers specifically to narrowing that occurs within the lumbar, or lower, portion of the spine. Likewise, cervical spinal stenosis refers to narrowing within the cervical, or upper, spine.
As Mayo Clinic explains, these types of spinal stenosis often have different symptoms. Cervical stenosis often causes tingling in the hand and may also have problems with balance. Lumbar spinal stenosis, on the other hand, “can cause pain or cramping in your legs when you stand for long periods of time or when you walk. The discomfort usually eases when you bend forward or sit down.”
What causes lumbar spinal stenosis?
Lumbar spinal stenosis is most often a degenerative condition that is caused by our body’s aging. As the American Academy of Orthopaedic Surgeons explains, there are other conditions that can exacerbate or increase your risk. The most common of these is arthritis.
“In the spine, arthritis can result as the disk degenerates and loses water content. In children and young adults, disks have high water content. As we get older, our disks begin to dry out and weaken. This problem causes settling, or collapse, of the disk spaces and loss of disk space height. As the spine settles, two things occur. First, weight is transferred to the facet joints. Second, the tunnels that the nerves exit through become smaller.
As the facet joints experience increased pressure, they also begin to degenerate and develop arthritis, similar to that occurring in the hip or knee joint. The cartilage that covers and protects the joints wears away. If the cartilage wears away completely, it can result in bone rubbing on bone. To make up for the lost cartilage, your body may respond by growing new bone in your facet joints to help support the vertebrae. Over time, this bone overgrowth-called spurs-may narrow the space for the nerves to pass through.”
Other less common causes of spinal stenosis include:
- A spinal canal that is naturally narrow
- Scoliosis, or curvature of the spine
- Tumors in the spine
- Achondroplasia, a condition that leads to dwarfism
- Paget’s disease, a rare condition that leads to abnormal bone destruction and regrowth
What are known risk factors for developing lumbar spinal stenosis?
The National Institute of Arthritis and Musculoskeletal Diseases reports that spinal stenosis is most common in people over the age of 50.
Other risk factors include:
- A history of injury to the back
- Gender, as more women than men suffer from spinal stenosis
- Poor posture
- Being underweight or overweight
- Improper alignment in the body
Since being overweight puts additional strain on the spinal canal, most healthcare professionals recommend weight loss as a primary goal for managing moderate cases of spinal stenosis.
What are lumbar spinal stenosis symptoms?
Lumbar spinal stenosis symptoms will affect everyone differently. As Spine-Health reports:
“For most people, symptoms of lumbar stenosis will typically fluctuate, with some periods of more severe symptoms and some with fewer or none, but symptoms are not always progressive over time. For each person, the severity and duration of lumbar stenosis symptoms is different and often dictates whether conservative (non-surgical) treatment or lumbar spinal stenosis surgery is more suitable.”
The most common lumbar spinal stenosis symptoms include:
- Pain in the back or buttocks
- Pain in the limbs, including the arms and legs
- Discomfort or pain while walking or standing upright
- Pain that is relieved when sitting, lying down, or leaning forward
- Weakness in the muscles
- Loss of bladder and bowel control
Symptoms of severe lumbar spinal stenosis
Lumbar spinal stenosis ranges in severity from mild pain or annoyance to a life-threatening condition. The most serious forms of lumbar spinal stenosis can develop into cauda equina syndrome. This condition is extremely rare, but requires immediate medical attention. The National Institute of Arthritis and Musculoskeletal and Skin Diseases explains that this condition:
“Occurs because of compression of the cauda equina, and symptoms may include loss of control of the bowel, bladder, or sexual function and/or pain, weakness, or loss of feeling in one or both legs.”
How do you diagnose lumbar spinal stenosis?
Since spinal stenosis shares symptoms with other conditions, a doctor will conduct a thorough physical exam and medical history to make a diagnosis. If more evidence is warranted, the National Institute of Arthritis and Musculoskeletal and Skin Diseases notes that the following tests may be ordered:
- CAT scan
- Bone scan
The best doctors for lumbar spinal stenosis pain will work closely with you to ensure that you get the correct diagnosis, and find the treatment options that work best in your case.
What are exercises for lumbar spinal stenosis?
Exercises for lumbar spinal stenosis are most effective for mild to moderate cases of pain. Our post “15 Spinal Stenosis Exercises You Can Do Anywhere” cover a number of exercise options that range from swimming or yoga to strength-building exercises to support the muscles of the back. However, your ability to perform these exercises will vary. As Back.com explains:
“For instance, most people with spinal stenosis can ride a bike and walk up an incline or flight of stairs without any pain. They can often walk for extended distances if they have something to lean on, like a shopping cart. However, if they are walking down an incline or flight of stairs, or if they have to give up the shopping cart, their symptoms will often reappear.”
Always talk to your doctor before attempting a new exercise program. They can advise you on the lumbar spinal stenosis exercises to avoid for your condition. They can also refer you to a physical therapist for more intense cases. Working closely with a physical therapist can be a highly-effective treatment option for finding pain relief from spinal stenosis.
If exercise or physical therapy doesn’t work, your next step is to explore spinal stenosis treatments.
What are common lumbar spinal stenosis treatments?
Lumbar spinal stenosis treatments range from non-invasive physical therapy and weight management to minimally-invasive injections to surgery. Most healthcare professionals will advise you to start with the least invasive procedures to find relief, before trying more invasive options. When you do talk to your doctor about your pain, FamilyDoctor.org recommends asking a few key questions to understand your risks and treatment options.
Medication for lumbar spinal stenosis
Medication can help relieve some of the more mild symptoms of spinal stenosis. Cleveland Clinic advises that:
“Non-steroidal anti-inflammatory medicines (NSAIDs) or pain-relieving medicines (analgesics) might be prescribed to decrease pain and increase your activity level. These medicines might be taken as pills, patches, topical cream/ointment or injections. Over-the-counter pain relievers, such as acetaminophen, might be effective as well.”
Epidural steroid injections for lumbar spinal stenosis
Epidural steroid injections are injections of steroids, often with an anesthetic, into the epidural space of the spine. MedicineNet.com reports:
“Cortisone (steroid) injections in the lumbar spine, referred to as epidural injections, can also reduce the symptoms by decreasing inflammation and swelling around the nerve tissue. These are sometimes repeated up to three times per year.”
Epidural steroid injections for lumbar spinal stenosis pain offer another option for patients who have tried physical therapy or medications with no success, but who don’t yet need surgery. Steroid injections are considered a safe, highly-effective procedure. The following video shows a live demonstration of a lumbar epidural steroid injection.
Lumbar spinal stenosis surgery
Surgery for lumber spinal stenosis should always be a last-resort option. Surgery carries its own side effects and risk factors. Because of that, ensure that you’ve talked with your doctor about other non-surgical approaches for treating your lumbar spinal stenosis. However, if your pain is severe and drastically impacts your quality of life, surgery may be a necessary option.
Lumbar decompression for spinal stenosis
Minimally-invasive lumbar decompression is a safe and effective procedure for people with lumbar spinal stenosis who want to improve their standing and walking tolerance. It’s still considered a surgery option, but is a less invasive option than most surgical techniques.
The American Association of Neurological Surgeons reports that:
“The most common surgery in the lumbar spine is called decompressive laminectomy, in which the laminae (roof) of the vertebrae are removed to create more space for the nerves. A neurosurgeon may perform a laminectomy with or without fusing vertebrae, or removing part of a disk. A spinal fusion with or without spinal instrumentation may be used to enhance fusion and support unstable areas of the spine.”
Other lumbar spinal stenosis surgical options include:
- Medial facetectomy
- Anterior, posterior, transforaminal, posterolateral, or instrumented fusion
If you suffer from lumbar spinal stenosis pain, it’s time to talk to a doctor to get a diagnosis and learn about the treatment options that could work for your condition. You can find a PainDoctor.com-certified doctor in your area to get the conversation started.