Lumbar Spinal Stenosis Treatment Options
What is Lumbar Spinal Stenosis?
The spine is made up of bones, disks and facet joints. The disks and facet joints allow the spine to flex, extend, turn and bend to the side. The disks are in the front of the spine. They support and allow movement between the vertebral bodies. The facet joints are in the rear of the spine. These small fluid filled joints allow the facet bones to slide back and forth with minimal resistance.
Spinal stenosis is the narrowing of the spinal canal. As people age, the lumbar disks dry out and collapse. The body stiffens the spine by thickening the spinal ligaments and hardening the disk and facet joints with bone spurs. Unfortunately, these changes result in the narrowing of the spine canal and compression of the spinal cord and/or nerves and blood vessels. This decreases the blood supply and oxygen to the nerves producing leg pain. The brain thinks the legs are the cause of the pain when it is actually the pressure in the back.
Spinal stenosis usually develops in patients between 50 and 80 years old. It is characterized by slowly worsening back and leg pain, numbness, tingling and weakness. The pain may be constant but is usually brought on by walking (called neurogenic claudication) or certain positions. It is relieved with sitting, lying down or using a shopping cart. People sometimes feel like they are walking on a cloud or cotton wool or that their legs do not belong to them. Rarely patients may develop urinary and bowel incontinence or retention. If this happens they should emergently contact there doctor.
How is this Diagnosed?
MRI scan is the best test to see if spinal stenosis is compressing the nerves. CT scan or CT myelogram (contrast dye injected into the spinal canal) is usually reserved for patients who cannot have an MRI. EMG (electromyelography) can help confirm nerve irritation and injury.
Patients who fail conservative treatment may benefit from surgical treatment. Traditionally a large skin incision was made over the spine and the back muscles were retracted to expose the spine to remove bone and ligaments compressing the spinal nerves. This is called a laminectomy.
Traditional surgery is more destructive in the approach to the spine compared to minimally invasive surgery. The larger the incision the more damage to muscle, ligaments and bone. This collateral tissue damage may result in more pain, back muscle weakness, instability and scar tissue leading to future difficulties. Minimally invasive surgery is done through a skin incision less than 1-inch, but it is more than just a small incision. The surgery is done through a tube in between back muscles to decrease muscle damage and weakness caused by muscle retraction. Minimally invasive surgery is not the same as “microsurgery”. “Microsurgery” only refers to the use of a microscope not the size of the incision or the amount of muscle damage.
New extremely minimally invasive endoscopic spinal surgeries are being developed for the treatment of spinal stenosis. The advantages of these procedures will include no general anesthesia, very small incision (size of finger nail), minimal postoperative pain and shorter recovery then current minimal invasive spine surgery.