Patient education: Lumbar spinal stenosis (The Basics)

What is lumbar spinal stenosis? — 

This is a condition that can cause pain, numbness, or tingling in the back or down the legs. "Lumbar" means that it affects the lower back (figure 1).

The back is made up of (figure 1):

●Vertebrae – These are the bones of the spine. Each has a hole in the center. The vertebrae are stacked on top of each other, and the holes form a hollow tube called the "spinal canal." The spinal cord passes through this tube and is protected by the vertebrae.

●Spinal cord and nerves – The spinal cord is the bundle of nerves that connects the brain to the rest of the body. It runs through the vertebrae. Nerves branch from the spinal cord and pass in between the vertebrae. From there, they connect to the arms, the legs, and the organs.

●Discs – Rubbery discs sit in between each of the vertebrae. These add cushion and allow movement.

●Muscles, tendons, and ligaments – These support the vertebrae and are used to stand upright as well as bend and flex the body. They are also called the "soft tissues" of the neck and back.

Spinal stenosis is a narrowing of the spinal canal or the spaces between the vertebrae (figure 2). This can put pressure on the spinal cord and nerves. This narrowing is usually caused by arthritis or injury. It can cause symptoms for different reasons:

●The vertebrae can form "bone spurs." These are bony growths that pinch the spinal cord or the nerves branching from the spinal cord.

●The discs can shrink and make the space between the vertebrae smaller. This can cause the vertebrae to pinch the nerves that pass between them. Discs can also bulge into the spinal canal and press on the spinal cord or nerves.

What are the symptoms of lumbar spinal stenosis? — 

Lumbar spinal stenosis does not always cause symptoms. When it does, the most common symptom is back pain, which can spread to the buttocks and down the legs. Some people also have tingling or numbness that spreads down the legs and loss of feeling in the feet. These symptoms usually affect both legs, but the symptoms can be worse in 1 leg than the other. Severe spinal stenosis can cause leg weakness or trouble controlling the bowels or bladder.

Symptoms of spinal stenosis are often worse while walking or standing upright. Usually, the symptoms get better if the person sits down or bends forward at the waist, for example, while leaning over a shopping cart.

Is there a test for lumbar spinal stenosis? — 

Yes. Imaging tests can show changes to the spine and spinal cord. These include:

●X-ray

●MRI

●CT scan or CT myelogram

In some cases, doctors also do other tests. This can help them figure out if symptoms are caused by spinal stenosis or another problem. They might do tests called "electromyography" ("EMG") or "nerve conduction studies." These measure how well electrical signals travel across the nerves that start in the spine. They can also show how well electrical signals travel from the spine to the muscles.

How is lumbar spinal stenosis treated? — 

Most people get a combination of treatments, such as:

●Pain medicines – Your doctor might recommend an "NSAID" medicine. NSAIDs include ibuprofen (sample brand names: Advil, Motrin) and naproxen (sample brand name: Aleve). If this does not help enough, they can prescribe other medicines.

●Medicines to relax your muscles (called muscle relaxants)

●Physical therapy – This can help you learn special exercises and stretches to improve your strength and flexibility.

●Weight loss – For people with excess body weight, weight loss can help reduce the strain on the lower back. Doctors often recommend diet changes and gentle forms of exercise, like swimming or bicycling.

●Injections of medicines that numb your back or reduce inflammation

Some people feel better for a while with treatments like:

●Spinal manipulation – This is when a chiropractor, physical therapist, or other professional moves or "adjusts" the joints of your back. If you want to try this, talk to your doctor or nurse first.

●Acupuncture – This is when someone who knows traditional Chinese medicine inserts tiny needles into your body to block pain signals.

●Massage – A therapist massages the muscles and other soft tissues in your back.

If your symptoms are severe or getting worse, your doctor might recommend surgery. Different types of surgery can used to treat lumbar spinal stenosis. A surgeon can remove a disc, bone spur, or part of a vertebra. They can also use hardware, like a metal plate, to hold the bones together.

Except in rare cases, surgery is usually considered only if other treatments do not work. Most people do not need surgery.

What can I do on my own to feel better? — 

One of the most important things you can do is to stay as active as possible. Even if you have some pain or discomfort, do not stay in bed or rest too long.

People used to think that bedrest was the best treatment for a bad back. The truth is that bedrest can actually make back problems worse. That's because the back can get weak and stiff with too much rest.

Find physical activities you like. If you have not been active for a while, start by doing just a few minutes of activity a few times a week. Then, slowly do more. Ask your doctor if there are any activities, such as bending or lifting, that you shouldn't do.

When should I call the doctor? — 

See your doctor or nurse right away if you have:

●Pain that is so severe that you cannot find a comfortable position

●A new problem controlling your bowels or bladder

●New numbness or weakness in your legs

●A problem called "foot drop," which is when you have trouble holding your foot up, for example, while walking

●Back or leg pain along with a fever or other symptoms that worry you

More on this topic

Patient education: Low back pain in adults (The Basics)
Patient education: Do I need an X-ray (or other test) for low back pain? (The Basics)
Patient education: Cauda equina syndrome (The Basics)
Patient education: Degenerative disc disease (The Basics)
Patient education: Laminectomy (The Basics)
Patient education: Thoracic or lumbar spinal fusion (The Basics)
Patient education: Cervical spinal stenosis (The Basics)

Patient education: Low back pain in adults (Beyond the Basics)