Spine Problems as We Age: Lumbar Stenosis
|Written by Lloyd Maliner M.D.|
SeniorLiving.Org Expert on Neurosurgery | Spinal Surgery
Lumbar stenosis refers to the narrowing of the spinal canal in the low back area of the spine. The spinal canal is the central opening in the spine through which the spinal cord and nerves travel on their way from the brain to all points of the body, particularly the arms and legs. An important anatomical concept to understand is that in the lumbar spinal canal there are only nerves, not the spinal cord. The nerves are much stronger and more resilient than the spinal cord, and the consequences of their being pinched are less. The classic problem associated with lumbar stenosis is pain in the back and legs associated with the standing position. Often the complaint is described as a heavy feeling or numbness, and sometimes it is only in the legs. The key component of the syndrome is that the problem is relieved upon sitting and bending over. These are the people walking hunched over a grocery cart or leaning on a cane, and taking frequent sitting breaks in the mall. As long as they sit or lean forward for a few minutes, the pain is relieved and they can continue for a short distance.
Patients with lumbar stenosis usually develop complaints over years, reaching a point that they can no longer stand or walk for more than a few minutes. There is rarely any urgency to treating lumbar stenosis as it usually only causes discomfort and not paralysis. This means that if someone develops sudden back problems and is found to have lumbar stenosis, the stenosis may not be the real issue. If a person develops sudden back problems it may be a “flare-up” of their underlying stenosis, or simply a strained back, and they will get better with supportive measures and not need surgery. On the other hand, the only way to “fix” lumbar stenosis is with surgery. Conservative measures such as traction, physical therapy, chiropractic care, medications, injection, etc. may temporarily easy the symptoms but they won’t change the anatomy. Therefore if the patient has progressively worsening problems and is not having adequate relief with these alternatives, surgery should be considered.
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There are a variety of surgical options to treat lumbar stenosis. The goal of all the surgeries is simply to open up the spinal canal so the nerves are not too tight, or pinched. The original procedure was a lumbar laminectomy, which was to remove the back part of the vertebrae and unroof the spinal canal. This is very effective, but can be a large operation if there are multiple levels of concern. Furthermore, removing this much bone can weaken the spine and occasionally leads to other problems. A new technique was developed to try and avoid these issues, the minimally invasive microlaminotomy. This procedure is performed through a small incision and creates a window in the bone through which the spinal canal can be accessed and cleaned out: almost a “roto-rooter” technique. The reason this surgery can work is because the nerves are usually being pinched more by thickened ligaments than by actual bone, and the pinching is occurring in a focused area. There are even newer techniques that are called minimally invasive that involve placing various implants in the spine to try and stretch these ligaments, but the long term success of these procedures is not known and the surgery to place these implants is not always so minimal. Every patient’s anatomy is unique, so there is no one right surgery for all. The good news is that if surgery is needed there are options available that may not involve a “major” surgery and extended recovery.
Updated: Apr 02, 2012