Lumbar Spinal Stenosis

The spinal canal runs through the vertebrae and, in the lower (or lumbar) spine, contains the nerves supplying sensation and strength to the legs. The characteristic syndrome associated with lumbar stenosis is termed neurogenic intermittent claudication If the stenosis is located on the lower part of the spinal cord it is called lumbar spinal stenosis . The problem usually causes back pain and leg pain that comes and goes with activities such as walking. These changes cause narrowing of the lumbar spinal canal which is known as spinal stenosis (figure). Over time, it narrows the diameter of the hose, just as spinal stenosis narrows the spinal canal.

Understanding the anatomy of the lumbar spine is critical to appreciating the various causes and treatment of lumbar spinal stenosis. The lumbosacral spine includes the five vertebral bodies L-1 to L-5, the sacrum, the intervertebral discs, the ligamentum flavum, and the spinal cord and cauda equina. Spinal stenosis occurs when there is impingement of the spinal cord, cauda equina, or the exiting nerve roots from the structures surrounding them. Most commonly, the impingement is multifactorial, including enlargement of the bony structure surrounding the canal, hypertrophy of the ligamentum flavum, and bulging of the intervertebral discs.

Causes of Lumbar Spinal Stenosis

Careful attention to the patient's history and physical examination is essential to make the diagnosis of lumbar spinal stenosis. Radiographic studies alone are insufficient to make the diagnosis because asymptomatic degenerative findings are often present on diagnostic imaging, particularly in older adults. Age at initial presentation varies depending on whether there is underlying developmental stenosis. Patients with developmental stenosis generally become symptomatic in their third through fifth decades of life, whereas patients with degenerative stenosis become symptomatic in the sixth through eighth decades of life. Here are the list of the possible causes of Lumbar Spinal Stenosis :

• The most common cause of lumbar stenosis is degenerative arthritis.
• A mass or tumor can also cause the narrowing of the space in the spinal canal.
• The main causes of cervical spinal stenosis ( CSS) include cervical spondylosis , diffuse idiopathic skeletal hyperostosis (DISH), or calcification of the posterior longitudinal ligament.
• There most likely is a genetic predisposition to this since only a minority of individuals develops advanced symptomatic changes
• Spinal stenosis usually occurs in older people after years of wear and tear, or degeneration of the spine

Symptoms of Lumbar Spinal Stenosis

Patients with symptomatic lumbar spinal stenosis classically present with the syndrome of neurogenic pseudoclaudication. This syndrome consists of complaints of buttock, thigh, and calf pain exacerbated with walking, standing, or lumbar extension and alleviated with sitting, lying, or lumbar flexion. Although calf pain is considered part of this clinical constellation, studies have demonstrated that calf pain can be present in as little as 56% of patients.

Conclusion and SUmmary: Lumbar spinal stenosis is a clinical diagnosis made on the basis of the patient's history, physical exam, and diagnostic imaging studies. Similarly, treatment must be based not only on the "hard facts" of MRI but also on the patient's preferences and expectations and mental and physical capabilities. More data are needed to help us make better decisions about which patients are best served by surgery (and what type) and which are best served by conservative therapy.

Some sign and symptoms related to Lumbaal Stenosis :

• Pain in one or both legs
• Your legs might also feel cramped, tired or weak.
• Numbness or tingling in the legs or feet
• Weakness in the legs
• Symptoms are often worse with prolonged standing or walking.
• These symptoms occur because the nerve roots are being tampered with, upsetting the normal signals that travel from the brain to the body.
• Cervical spinal stenosis may cause similar symptoms in the shoulders, arms, and legs; hand clumsiness and gait and balance disturbances can also occur.

Treatment of Lumbar Spinal Stenosis

• A variety of treatment options exist for spinal stenosis, and in most cases simple therapies such as mild pain medications and rest are effective in relieving the immediate pain.
• Medications, including non-steroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and pain, and analgesics to relieve pain
• Physical therapy and/or prescribed exercises to help stabilize the spine, build endurance and increase flexibility.
• These treatments may include anti-inflammatory medications (orally or by injection) to reduce associated swelling or analgesic drugs to control pain.
• A posterior approach in which the cervical spine is reached from the back of the neck and involves the surgical reconstruction of the posterior elements of the cervical spine to make more room for the spinal canal.

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