A Family Doctor's Tale - Lumbar Spinal Stenosis

DOC I HAVE A LUMBAR SPINAL STENOSIS

Lumbar Spinal Stenosis is a condition due to the narrowing of the spinal canal either in the central part or peripheral(lateral) to the the side in the nerve root canal.
This results in pain in one leg without back pain

Every one can get Lumbar Spinal Stenosis.

The age of onset is usually in the late 40's.

It is also more common in men than women .

The causes of lumbar spinal stenosis are:
1.congenital - in born narrowing of the spinal canal

2.Acquired
a.carrying heavy objects improperly with the back instead of the knees

b.trauma or injury to the spine or pelvic bone

c.staying in crouched or seated positions for too long

Symptoms:
1.The onset is usually gradual with bouts of back pain and stiffness over weeks or months.

2.Early morning stiffness and pain occurs,then wears off during the day.

3.It gradually affects the lower limbs with pain and stiffness.

4.Typically there is low back pain radiating to the buttocks and leg which is aggravated by activity especially walking

Signs:
1.Physical signs are not present in early cases

2. there may be a Simian stance (like a monkey) with flexion at the hips and knees

3.Spinal movements are restricted

4.motor, sensory and reflex abnormalities present in one or both lower limbs

4.sphincter impairments may be present rarely

Diagnosis:
1.medical history of duration of symptoms and the extent of pain in the back and legs

2.neurological examinations of deficits in the spinal nerve

3.Confirmation is usually by a  x-ray of the spine and pelvis.
-disk height, narrowing of intervertebral space, bone spurs or osteophytes

4.MRI or CAT scans will show clearly the spinal narrowing or narrowing of the nerve root canals

Treatment:
Conservative Management:
1.physiotherapy with traction and short wave diathermy
strengthening of spinal muscles

2.spinal support with corset or light weight brace

3.Proper usage of back muscles

4. medications such as NSAIDs

5.epidural steroid injections

Surgery:
surgery may be needed if:
1. the patients do not improve with above treatments

2.the symptoms become progressively worse

3.weakness of legs

4.loss of bowel or bladder function

There is lumbar decompression surgery
1.Laminectomy or removal of disk

2.foraminotomy to widen the hole where the nerve root comes out.

3.Spinal fusion to strenthen the spine  and prevent abnormal loose movement of the spine

Prognosis:
Usually very good after surgery

Prevention:
Symptoms comes and go.

There should proper posture during sitting, standing and carrying heavy things

With exercise and strengthening of the spinal muscles, pain is reduced and flexibility of the spine is improved especially with regular exercise and proper posture.

Lumbar Spinal Stenosis is never life threatening and can be controlled but not cured.