Back problems are extremely common, affecting around one in six Australians. Having a back condition can interfere with your home life, ability to work, and enjoyment of your leisure time. One common cause of lower back problems, particularly in people who are older, is lumbar spinal stenosis.
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What is lumbar spinal stenosis?
The term ‘stenosis’ simply means narrowing. When this narrowing affects the lower part of your back (known as the lumbar spine), healthcare professionals call this lumbar spinal stenosis.
Lumbar spinal stenosis is a degenerative condition which leads to changes in the discs, ligaments and small joints (called facet joints) of the lower back. These changes result in narrowing of the canal around the nerves and blood vessels of the spine.
What are the symptoms of lumbar spinal stenosis?
Many people with lumbar spinal stenosis experience no symptoms whatsoever, with the condition only discovered when they have tests for other things (such as an X-ray of the belly or pelvic area). However, a significant number of people with the condition do experience symptoms, which can range from mild to debilitating.
These symptoms include leg and back pain. Weakness or numbness that is typically worse with standing and walking and relieved by sitting or lying down is also common. Healthcare professionals call this sign of lumbar spinal stenosis ‘neurogenic claudication’.
If you have lumbar spinal stenosis, you might also experience symptoms that mainly (or only) affect one leg. This is more common with a pinched nerve on one side of the spine, making the diagnosis of lumbar spinal stenosis more difficult.
How do I know if lumbar spinal stenosis is causing my symptoms?
Your healthcare professional can make this diagnosis. They will ask you some questions about your symptoms, such as when they started, whether they follow a pattern, and how they are affecting your everyday life. They will also perform a physical assessment. This might include things like feeling your spine and asking you to bend forwards, backwards and sideways.
You will probably also be sent to have some tests. An MRI is the gold standard of investigations for lumbar spinal stenosis. However, a CT scan is often performed first because of access and cost considerations with MRI.
These assessments all help to build up a picture of what’s causing your symptoms, as well as which treatment options may work best for you. They also help to rule out other causes of your symptoms, including any rare but potentially serious conditions.
What are my treatment options?
If you have symptoms resulting from lumbar spinal stenosis, various treatment options are available. Conservative management includes physiotherapy, simple pain relief medications, regular exercise, and support to achieve a healthy body weight if needed. Some people get temporary relief from minimally invasive procedures such as a local steroid injection.
Surgery may be considered if conservative management doesn’t adequately relieve your symptoms, or if symptoms are significantly affecting your quality of life or your mobility. For people aged 65 and over, symptomatic lumbar spinal stenosis is the most common reason for having spine surgery. Surgery commonly involves a procedure called a decompressive lumbar laminectomy, in which a small amount of tissue is removed or cut to free up space and relieve pressure in the spinal canal.
Minimally invasive spinal surgery
This type of surgery used to involve making an incision down your spine. However, it is now performed as a minimally invasive procedure using a very small incision. Many neurosurgeons at the Gold Coast Private Hospital perform the surgery this way.
The benefits of minimally invasive surgery include reduced pain afterwards and faster recovery times. Your surgeon can talk to you about whether this is a suitable option for managing your condition.
Written by A/Prof Chris Daly, Spine Surgeon & Neurosurgeon at Gold Coast Private Hospital.
