Lumbar Spinal Stenosis

GENERAL INFORMATION:

What is lumbar spinal stenosis? Lumbar (LUM-bahr) spinal (SPI-nal) stenosis (ste-NO-sis) is a narrowing of the spinal canal in the lower back. The spinal canal runs in the middle of the spine and contains the spinal cord. Your spine is made up of many vertebrae (back bones) stacked on one another. Between each bone is a disc which serves as cushion. The spinal cord is where nerves that carry messages from your brain go to the rest of the body. When lumbar spinal stenosis happens, the nerves that go to the legs may be squeezed. With treatment, more serious problems of lumbar spinal stenosis may be prevented and your quality of life improved.

What causes lumbar spinal stenosis? Lumbar spinal stenosis may be caused by any of the following:

• Abnormal bone development: This means that your spine may have grown abnormally, such as in scoliosis (curved spine) or dwarfism. Some people may also have been born with a narrow spinal canal.
  
  
• Degeneration: Changes in the spine and the parts around it may develop as you age. The discs between the vertebrae may bulge, slip, or lose its cushioning effect. The vertebrae may move or twist, or bone spurs may develop in them. The ligaments that connect the vertebrae to each other may thicken and cause narrowing of the spinal canal.

What are the signs and symptoms of lumbar spinal stenosis? Spinal stenosis may occur without causing any symptoms. Signs and symptoms may include any of the following:

• Low back pain.
  
  
• Pain, numbness, tingling, or weakness of the legs that gets better when sitting down, leaning forward, or bending.
  
  
• Pain in the buttocks that extends to the thighs or legs.
  
  
• Trouble standing or walking.
  
  
• Trouble urinating or moving the bowels.

How is lumbar spinal stenosis diagnosed? Your caregiver will need to take a detailed health history from you. A physical exam will also be done. Your caregiver will carefully check the parts of your body to look for abnormal changes or movements. He may do things to check how well you feel and how strong your muscles are. You may be asked to do certain movements, such as lift, bend, walk, sit, reach, or run. Certain tests may be done that use a special dye to help organs and structures show up better. Tell caregivers if you are allergic to iodine or shellfish (lobster, crab, or shrimp), as you may also be allergic to this dye. You may have any of the following tests:

• Computed tomography scan: This is also called a CT myelogram. An x-ray machine uses a computer to take pictures of your body. It may be used to look at your bones, muscles, blood vessels, and other tissues. You may be given dye as a shot in your back before the pictures are taken. The dye may help your caregiver see the parts inside the spinal canal better.
  
  
• Electromyography (EMG): Electromyography is a test that measures the electrical activity of your muscles. Your muscles are tested at rest and while you are using them. An EMG test may also check the nerves that control your muscles.
  
  
• Magnetic resonance imaging: This test is called is also called an MRI. During the MRI, pictures are taken of your body. An MRI may be used to look at the muscles, joints, bones, blood vessels, or other tissues. You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This can cause serious injury.
  
  
• X-ray: This is a picture of your back bones. You may be given dye as a shot into your spinal canal before the x-ray. This dye will help the bone, spinal cord, and other parts show up better on the x-ray. An x-ray to show the contents of the spinal canal using dye is called a myelogram.

How is lumbar spinal stenosis treated?

• Medicines: Caregivers may give you painkillers or steroids to decrease pain or swelling. There are medicines that help ease pain by making you feel more relaxed or help you sleep better.
  
  
• Surgery: You may need surgery if your pain cannot be controlled by other treatments. It may also be done if your weakness worsens, or bowel and bladder problems are present. Surgery by cutting a part or making a hole in the spine to open the canal may be done. The bones may also be fused together to make the spine stable.
  
  
• Therapies:
  
  
  • Occupational therapy: Occupational therapy (OT) uses work, self-care, and play activities to help you in your daily life. OT teaches special skills for bathing, dressing, cooking, eating, or driving. An occupational therapist may help you choose tools to use, and suggest ways to keep your home or workplace safe. You and your therapist will plan a therapy program that is right for you.
    
    
  • Physical therapy: A physical therapist helps you with special exercises. These exercises help make your bones and muscles stronger.
  
  
• Other treatments: These treatments may be used to help decrease your pain. You may need to rest or change your physical activities. Caregivers may use heat or ice, ultrasound, or massage. You may do specific exercises to stretch the muscles of the hip. These may include stationary bike riding, up-tilt treadmill walking, and water exercises.

Where can I find more information? Having a lumbar spinal stenosis may be life-changing for you and your family. Accepting that you have a lumbar spinal stenosis may be hard. Contact the following for more information:

• American Academy of Family Physicians
  PO Box 11210
  Shawnee Mission, KS 66207-1210
  Phone: 1-913-906-6000
  Web Address: http://www.aafp.org
  

• American Academy of Orthopaedic Surgeons
  6300 North River Road
  Rosemont, IL 600184262
  Phone: 1-847-8237186
  Web Address: http://www.aaos.org/
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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