Lumbar Canal Stenosis

Spinal stenosis is a narrowing of the spinal canal, the bony structure that encloses the spinal cord and the nerve roots. It represents a “slow progressive” compression of neural elements.

The age-related wear and tear or degeneration, in the spine is an on going process that accelerates around 30 years of age.

What are its Symptoms?

Symptoms of spinal stenosis are produced when the narrowing spinal canal compresses the spinal cord or nerve roots.

  • Pain, tingling or weakness/heaviness in one or both legs that becomes worse with standing or walking. These symptoms are often relieved with sitting or leaning forward, as while pushing a shopping cart. This is called neurogenic claudication, and it occurs in 90% of spinal stenosis cases.
  • Weakness, numbness or pain that radiates to the buttocks and legs. These are symptoms of radiculopathy or compression of a lumbar nerve root.

What are its Causes?

  • In majority of the patients spinal stenosis results from degenerative changes that occur with aging called asspondylosis or spondylitis. Other possible contributors to spinal stenosis include the thickening of ligaments within the spinal canal; the degeneration, herniation or bulging of intervertebral discs; and the formation of synovial cysts (fluid-filled sacs in the joints).

Tests and Diagnosis :

The diagnosis of spinal canal stenosis is made by –

  • Complete history and physical examination
  • MRI scan and X-rays.
    • Magnetic resonance (MR) imaging – provides detailed images of soft tissues like the spinal cord and nerve roots. As a result, MRIs are very helpful in determining the location and severity of the stenosis and in identifying spinal cord or nerve root compression.
    • X-Rays – helps in diagnosing specific bony abnormalities such as bone spurs, disc space narrowing, vertebral body fracture, collapse or erosion.
  • Dynamic, or flexion/extension X-rays (X-rays that show the spine in motion) may be obtained to see if there is any abnormal or excessive movement or instability in the spine at the affected levels.

When to treat it?

  • Since the rate of narrowing of the effective space varies, the patient symptomatology varies. Modification of lifestyle and exercise help to control pain and maintain a relatively active lifestyle.
  • However “slow progressive functional paralysis” requires a surgical intervention. Though a true paralysis is rare, the activities slow down to an extent wherein routine activities are painfully restricted.

How is it treated?

  • Depending on the patients symptoms and severity nonoperativeand operative decision is taken. Non operative treatments in the form of anti-inflammatory medications, physical therapy, weight control, or pain management techniques such as epidural spinal injections are considered in less severe symptoms.
  • When nonoperative treatments don’t help or stop working, surgery often provides relief.
  • For patients with persistent neurogenic claudication, a decompressive lumbar laminectomy or decompression with stabilization(Transforaminal Lumbar inter body fusion) may be recommended.
  • Is done done through minimally invasive technique:
    • Yes.