Lumbar spinal stenosis

Introduction

Lumbar spinal stenosis is a condition in which the space around the spinal cord (the spinal column) narrows, compressing a section of nerve tissue.

Sometimes, the condition causes no symptoms. However, it can put pressure on the nerves that run out of the spine or on the spinal cord which may cause symptoms such as pain, muscle weakness, tingling and numbness.

Lumbar spinal stenosis is a common condition that usually affects people aged over 50. It is most commonly caused by age-related wear and tear changes in the spine.

Treatment most often involves simple strategies, such as painkillers, physiotherapy and staying active. In some cases, steroid injections or surgery may be needed.

Symptoms

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Early lumbar spinal stenosis may have no symptoms. The symptoms tend to gradually develop over time.

The symptoms of lumbar spinal stenosis may include:

  • pain or burning that spreads into the buttocks and down into the legs
  • back pain
  • numbness, tingling, cramping or weakness in the legs

The symptoms usually start when walking or standing up. They tend to go away when sitting, lying down, or bending forward, for example, when leaning over a shopping trolley.

In rare cases, the compression of the nerves can cause a more serious condition called cauda equina syndrome.

See your doctor immediately or go to the nearest hospital if you have symptoms of lumbar spinal stenosis, as well as bladder or bowel problems and/or numbness around your back passage or genitals, or weakness in your legs.

Causes

Lumbar spinal stenosis is most commonly caused by degenerative wear and tear changes that occur in the spine as part of the ageing process (osteoarthritis).

These changes lead to the narrowing of the spinal canal, or of the spaces between the bones of the spine (vertebrae) where the spinal nerves pass through.

Other risk factors for lumbar spinal stenosis include:

Diagnosis

Your doctor may suspect lumbar spinal stenosis based on your symptoms and an examination.

The diagnosis is usually confirmed with an MRI scan. If you are unable to have an MRI, your doctor may recommend a CT scan or CT myelogram in which dye is injected into the space around your spinal cord.

Other investigations may include an X-ray.

Treatment

The treatment you receive for lumbar spinal stenosis will depend on how severe your symptoms are.

If your symptoms are mild you may be given self-care advice on how to manage your symptoms, such as:

  • keeping active/exercise
  • limiting heavy lifting and avoiding prolonged sitting
  • using a cane or walker
  • losing weight
  • taking non-prescription painkillers, such as ibuprofen or paracetamol

Other treatments include:

  • medication such as prescription painkillers, anti-inflammatory drugs or nerve pain medication
  • physiotherapy
  • steroid and local anaesthetic injections into the spine
  • deep heat and massage (though the benefit isn’t yet proved)
  • a back brace in certain situations

If your symptoms do not improve after treatment, your doctor may refer you to a bone specialist (orthopaedic surgeon). They will be able to discuss your options for surgery.

This surgery usually involves the removal of a section of the spinal bone that is compressing the nerves (lumbar decompressive surgery).

Another type of surgery involves placing an implant between two vertebrae to help to reduce the pain in your legs when you stand up or walk. But how long this effect lasts is unknown.

The outcome you can expect after surgery varies from person to person. There is no concrete evidence that shows exactly how effective surgery is at treating lumbar spinal stenosis.

Living with lumbar spinal stenosis

The outcomes of treatments for lumbar spinal stenosis can vary from person to person. Generally, treatments are usually successful at reducing your symptoms but they may not cure the condition completely.

Without treatment, the symptoms of lumbar spinal stenosis usually get worse.

Staying as active as possible and avoiding lots of bed rest can help improve the symptoms of lumbar spinal stenosis while helping to prevent your back from getting weak and stiff.

You may also need long-term physiotherapy and rehabilitation therapy to help strengthen your back and return to normal functioning after surgery.

If you have lumbar spinal stenosis, or suspect you do, speak to your doctor. He or she may be able to help you create a management plan. This may involve guiding you to exercises which are safe for you and referring you to any specialist services.

To find answers to any other health questions you might have, visit our Health A-Z.

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