Focus on Spinal Stenosis

Spinal Stenosis is a condition caused by the narrowing of the spinal canal causing the nerves to be pinched – leading to persistent pain in the buttocks, limping, lack of feeling in the lower extremities and decreased physical activity. There are several forms of lumbar spinal stenosis. The most common is degenerative stenosis, which occurs in virtually the entire adult population as a result of the natural process of aging. As the body dehydrates with age, bones become less dense and the discs of the spine loose mass. The discs compress, causing tilting, slippage and rotation of vertebral bodies. This results in compression of the spinal sac and nerve roots. As these narrowing results in a compression of the spinal nerve and nerve roots, this in turn causes a wide range of symptoms.

Congenital lumbar stenosis relatively rare and presents at an early age, often between 30 and 40. Acquired Lumbar Stenosis is more common and develops when patients are in their 60’s or older. It is a puzzling condition – as it can neither be predicted nor prevented and does not distinguish between sex, race or ethnicity.

Don’t forget to check the pulses of all patients to rule out vascular claudication, or check for hip osteoarthritis.

Symptoms

  • Dull to severe aching pain in the lower back or buttocks when walking or doing other activities
  • Pain radiating into one or both thighs and legs Numbness, weakness or paraesthesia involving the lower extremities
  • Symptoms relieved by bending forward, sitting or lying down Pain relievers tend to be ineffective Gradually reducing walking distance.

Treatment

  • Conservative measures can be tried first. These include pain killers and anti-inflammatory medication and physiotherapy.
  • Physical therapy is usually ineffective in most cases. If conservative measures do not work injections- epidural or a nerve root may be offered to inject some local anaesthetic and steroids around the inflamed nerve.
  • If these measures do not work surgery may be considered to take the pressure off the nerve and stabilise the spine.
  • This operation is called a lumbar decompression and stabilisation. Posterior Lumbar Disc Replacement represents a significant recent development in the treatment of lumbar degenerative conditions. Posterior lumbar disc replacement is designed to replace degenerative discs and facets of the lumbar spine.
  • The surgery takes 2-4 hours, hospital stay is 1-3 days, and more than 90% of patients report significant improvement in their symptoms, particularly their ability to walk.

Spinal stenosis video animation