Periodically we will be discussing articles of interest to patients and putting on presentations of selected topics. The first topic to be presented is Lumbar Stenosis. The information comes from a Chapter I authored in the Essentials of Physical Medicine and Rehabilitation. Lumbar stenosis is a very common problem that causes back pain for over 8 to 11 percent of the US population. It is more common in people over 50 years of age. As the "baby boomers" age an estimated 2.4 million Americans will be affected.
Spinal stenosis is a condition in which the spinal cord, and other nerve structures are compressed due to tightness of the spinal canal, and the areas where the nerve roots exit the spinal canal; called the intervertebral foramen.
The nerves can be pinched at these areas from herniated discs, lax ligaments or hypertrophy of the facet joints. When the nerves are pinched in the middle of the spinal canal it is called Central Stenosis; when the nerves are pinched in the foreman it is called lateral stenosis.
Most people with lumbar stenosis are over 50 and have had chronic low back pain for years. Leg pain is the main complaint in 90% of patients. The pain is usually below the buttocks but may go below the knee. It usually affects both legs.
Most people feel better when sitting. They usually report the pain is brought on by walking and relieved by sitting or bending the back. In fact most people can tell exactly how far they can walk before the pain gets bad. Lying on your stomach may also bring on the pain. Patients with lumbar stenosis usually walk stooped over and may have weakness of the thigh muscles. Some patients also have numbness of the legs.
Walking distance is decreased due to leg pain.
Stiffness of the back and the leg muscles develops and the patient's balance and ability to walk gradually decreases.
The best test to diagnose lumbar stenosis is an MRI of the spine. Other tests including EMG / NCV and Doppler studies may be needed to evaluate for neuropathy and vascular disease.
Conservative treatment with NSAIDs, Gabapentin, and Physical Therapy usually helps.
The therapy consists of special exercises to flex the spine and increase the space where the nerves exit the spine. These exercises are supplemented by mechanical lumbar traction and methods to relax and strengthen the tight back and leg muscles.
Some people may go for lumbar epidural injections for temporary pain relief.
Finally surgery may be needed to release the pressure on the nerves by decompressive laminectomy and other techniques.
Many people can be helped with conservative treatments
For more information come in for a copy of the chapter or make an appointment for an evaluation. We look forward to helping you. Walter J Gaudino MD MSPT FAAPM&R