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Apr
24

Lumbar spinal stenosis: Part 1 of 2

Dr. Mackarey's Health & Exercise ForumLUMBAR SPINAL STENOSIS

PART 1:

We all have known or seen someone with spinal stenosis, perhaps without even realizing it. Those with spinal stenosis often suffer from lower back pain with the additional complaints of pain, numbness and weakness in both legs when standing or walking but feel much better sitting. They are is frustrated by the fact that they cannot enjoy their passions such as: golfing, walking, hiking, cooking and baking, if it requires prolonged standing or walking. Spinal stenosis sufferers are often over 65 years of age and can be seen sitting on a bench at the mall to avoid prolonged walking or standing leaning over a shopping cart in the grocery store to avoid standing upright into and extended posture.

Definition and Diagnosis

In technical terms, stenosis is an abnormal narrowing of a hollow tube or canal. When used in reference to the lower back, this narrowing is called lumbar spinal stenosis. Lumbar spinal stenosis is an extremely common cause of disabling back and leg pain in older individuals. Since these individuals tend to avoid the painful activities of standing and walking, they become deconditioned and lose their independence. It must be emphasized that, although spinal stenosis is a progressive process, symptoms generally will not lead to leg paralysis. However, it can lead to weakness and poor endurance of the muscles in the legs and remains the most common reason for undergoing spinal surgery after the age of 65.

There are two types of lumbar spinal stenosis. Central stenosis is a narrowing of the spinal canal surrounding the spinal cord. Symptoms produced will affect both legs, and may cause bowel and bladder disturbances. Lateral stenosis is a narrowing of the exit for the nerve root. Since lateral stenosis involves a single nerve root, symptoms are localized to a specific area of the leg. Symptoms are dependent on the following factors: the amount and location of compression on the nervous tissues and the amount of inflammation present. Therefore, symptoms are not identical between individuals, may vary over time in the same individual, and can be inconsistent.

Two causes of spinal stenosis have been identified:  Congenital or developmental defects (something you born with or occurs when developing) (e.g. scoliosis, dwarfism, trefoil or misshaped canal); Acquired through degenerative changes, fractures, spondylolisthes (boney instability), postoperative scar tissue, tumors, or systemic disease. Additional spinal changes may accompany spinal stenosis are: disc/joint degeneration, ligamentous, thickening, bone spurs, and disc bulging.

A person who has spinal stenosis is typically over fifty years of age with either a long history of low back pain/ache/stiffness or symptoms that have seemed to develop for no apparent reason. The symptoms, which are more intermittent than constant, can be made worse by inclement weather. The back pain may extend into the tailbone or buttocks and may be accompanied by poorly localized pain, tingling, numbness, cramping, discomfort, tightness, burning, and/or weakness in one or both legs. These complaints will increase with standing and walking because extension of the spine (as in erect posture, reaching overhead, and backward bending) and spinal compression (a normal part of bearing weight through the legs) narrows the canal that surrounds the spinal cord and nerve roots. Conversely, sitting will decrease symptoms since flexion (as which occurs with forward bending) increases canal diameter. This postural dependency of the symptoms is a unique characteristic of individuals with spinal stenosis and explains why these people prefer sitting to walking. When walking they will stoop or slouch forward and/or walking behind a shopping cart or lawnmower to support themselves as they lean forward.

An individual with spinal stenosis may have several of the following symptoms:

  • Diminished walking tolerance –Is the most troublesome and common complaint.
    • Reduced arch in the lower back.
    • Limited, painful backward bending.
    • Tight and weak leg muscles
    • (33% of the people with spinal stenosis)
  • Decreased reflexes– (50% of the people with spinal stenosis).
  • Decreased sensation but with normal pulses
  • Muscle wasting of thighs and calves.
  • Pain with coughing or sneezing.

Spinal stenosis can be a complicated and multifaceted problem. If you have some of these symptoms consult your family physician. If the physician suspects that you may have spinal stenosis, the following advanced diagnostic imaging studies may be recommended:

  • X-rays: to view the boney degenerative changes and the canal around the nerve root (limited view).
  • MRI – accuracy reported to be quite high.(most commonly used for diagnosis)
  • Electromyogram/Nerve Conductions Tests
    • – used to supplement MRI and to determine the health of the nerves
  • CT scan – 82% accuracy ; 91% when used with a myelogram.
  • Myelogram – 76% accuracy;
    • disadvantage: adverse reaction to dye. (rarely used today)

Next week’s article will discuss prevention and treatment for lumbar spinal stenosis.

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” in the Scranton Times-Tribune.   

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.