Lumbar (spinal) Stenosis
Stenosis is a narrowing of a tube. In spinal stenosis the central bony tube of the spine is narrowed. This tube (the spinal canal) contains the spinal cord in the upper part of the spine, and the lumbar nerves in the lower (lumbar) region.
The narrowing is most commonly due to degenerative (arthritic) changes in the spine. It can also be caused by a disc prolapse (slipped disc), a malalignment of the spine, and even a lesion in the canal itself.
It is a common problem in people from age 70 onwards, though can occur in younger age groups.
The most frequent symptoms of lumbar stenosis are a cramping in the buttocks or legs, usually when walking, though standing can also bring it on. Other symptoms include nerve pains into the legs (‘sciatica’), a feeling of heaviness or tiredness in the legs and sometimes unsteadiness. This commonly results in an inability to walk as far or as fast as usual.
Other conditions can also cause these symptoms, the commonest being a lack of blood flow into the legs. Sometimes special tests may be ordered to see if these other conditions exist.
Narrowing of the upper spine (cervical stenosis) can result in pressure of the spinal cord itself. This can give a wide range of symptoms with the commonest being: Loss of fine hand control (such as difficulty doing up buttons or sewing); bladder problems; sexual dysfunction; unsteadiness or staggering when walking.
The diagnosis of stenosis is based mainly on the patient’s description of the symptoms and an MRI scan of the spine.
Mr Cass will make the diagnosis after hearing your symptoms, examining you and usually he will arrange an MRI scan. He would then go through the scan with you, and discuss the diagnosis and treatment options available.
Depending on the severity of symptoms and the results of the MRI scan, the usual treatment options include simply keeping a watchful eye on the situation (usually the stenosis does worsen slowly with time); maybe with some physical therapy to keep your back well supported and your posture as good as it can be.
Other options include trying to reduce the inflammation of the squeezed nerves by putting some steroid (a local anti-inflammatory) into the spine around the nerves, usually via an epidural injection. This option is however now only recommended for a very few cases.
The final option is surgery to remove some of the arthritic or other tissue which is causing the narrowing in the first place. This operation is called a decompression (as the aim is to take the pressure off the nerves). It is a very common operation for stenosis and has a very high success rate at relieving symptoms in the buttocks and legs (between 80-90% of patients having the surgery get a significant improvement in their leg symptoms and can walk further).
Click here for a more detailed explanation of either an epidural injection or decompression surgery.
If you feel you may have stenosis, or if you have already been given this diagnosis, and would like to discuss it with Mr Cass, please call us on 01273 828098 to make an appointment.