Condition: Lumbar stenosis (LSS) is a syndrome that results from the narrowing of the canal in the lower spine, which can put pressure on the spinal cord or nerves that provide sensation to the legs, resulting in pain, tingling, and/or weakness.
Background: The most common cause of LSS is spinal degeneration from wear and tear due to aging and osteoarthritis, although many other causes, including bone disease, malformations, tumors, injury, and herniated disks, have also been described.
Risk Factors: Increasing age is the most significant risk factor for LSS, which is the leading diagnosis for adults over age 65 years who undergo spinal surgery. In younger patients, genetic conditions are the underlying cause.
History and Symptoms: The most common symptom of LSS is pain in the buttocks, thigh, calf, and groin. Patients may also experience tingling sensations, weakness, cramping, or fatigue in the legs. Symptoms usually occur in both legs with walking. Pain often improves upon sitting or leaning forward as if “pushing a shopping cart”.
Physical Exam: A complete examination of the spine in the lower back will be performed in order to assess pain, range of motion, structure, muscle strength, sensation, and reflexes. Walking will also be observed. Blood vessel disease should be ruled out through examination of peripheral pulses and hair/skin. Functional surveys/inventories may be used to assess patient limitations.
Diagnostic Process: MRI is considered the best option for diagnosis for LSS, although X-rays and CT Myelogram can also be used for imaging of the spine to aid in diagnosis, which should include a combination of imaging and symptom assessment. Electrodiagnostic studies can also be used in combination with these other techniques.
Rehab Management: Treatment includes modification of activities that increase pain, rehabilitation exercises for strengthening and flexibility, and back support braces. Medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), opiates, medications used to treat nerve pain, and muscle relaxants, are available to treat pain. Epidural steroid injections, acupuncture, and electrical stimulation can also be used for symptom relief. Surgery is another option, and 80% of patients report some symptom relief after surgery.
Other Resources for Patients and Families: Home exercise programs are useful for patients to maintain mobility, strength, and range of motion. Patients and families should be educated on activity modifications, and vocational rehabilitation may be useful to enable the patient to return to work.