Signs of Lumbar spine stenosis (Back spinal stenosis)

Description

The most common cause of lumbar spinal stenosis is degenerative arthritis. As one ages the bones, discs and ligaments can begin to wear out resulting in loss of cartilage, extra bone formation (osteophytes), and loss of height of the discs. These processes cause a reduction in the normal spaces for the nerves to travel resulting in compression of the nerves and the symptoms of pain, weakness and numbness. Other causes include bone diseases such as Paget's, tumors and injury.

Symptoms

Low back pain, weakness, numbness, loss of bowel or bladder control, and/or muscle cramping.

Tests

A history and physical exam will be done. If there is severe narrowing the provider may find numbness, weakness, or problems with the reflexes. A CT scan can detect the narrowing and an MRI can reveal damage to the nerves from compression.

Standard Workup

CT Scan
MRI

Treatment

The course of therapy depends on the severity of the narrowing and the symptoms. Medical treatment is usually tried first and consists of antidepressants (amitriptyline/Elavil), anti-seizure medications (gabapentin/Neurontin, pregabalin/Lyrica), non-steroidal anti-inflammatory medications (ibuprofen/Motrin, naproxen/Naprosyn) and opiates (hydrocodone/Vicodin, oxycodone/Percocet). Epidural steroid injections can be helpful in reducing inflammation and determining if surgery may be helpful. Surgery may be indicated for patients that do not improve with the above treatments. Typically surgery consists of enlarging the narrowed areas and is called a laminectomy.