Lumbar spinal stenosis describes a congenital or acquired condition, where the degenerative acquired form is by far the most common. Stenosis means narrowing and these in turn leads to compression and irritation of neural structures including the thecal sac, traversing and exiting nerve root. Acquired degenerative stenosis is thought to result from a cascade of changes initiated by the degeneration of the intervertebral disc as a person age. Degeneration and atrophy of trunk muscles, repeated trauma to the spine from daily wear and tear, and potential occupational hazards lead to the desiccation of parts of the disc and collapse of the disc space. This process may be exacerbated by weak or degenerating spinal muscles, especially if coupled with fatty infiltration of the paraspinal girdle, and excessive body weight
Frequently Asked Questions
What is spinal stenosis?
Lumbar spinal stenosis is a degenerative process in the low back that is extremely frequent in today’s older population. Essentially, it means narrowing of the spinal canal in which the spinal cord runs through. Lumbar spinal stenosis is considered a pathological process where bony, ligamentous, and synovial elements of the lower axial spine degenerate and overgrow, progressively causing this narrowing and compressing the neural and vascular elements in the spinal canal. This can result in impingement on the nerves of the cauda equina or on the thecal sac itself.
What are the symptoms of a spinal stenosis?
Lumbar spinal stenosis can cause debilitating symptoms such as severe leg pain, or restriction in the perimeter of ambulation, both resulting in dependency in daily activities. Compression of the neural and vascular structures can be asymptomatic if it is mild or can result in a variable combination of static back pain, radicular lower extremity pain, or neurogenic claudication. Static symptoms are typically exacerbated by walking or extension of the lumbar spine and are temporarily relieved by bending forward, sitting or lumbar flexion manoeuvres, thus promoting an increasingly kyphotic posture in patients with the disease.
The diagnosis of lumbar spinal stenosis is made by reconciling an array of clinical symptoms with radiographic findings of lumbar stenosis on computed tomography (CT) or magnetic resonance imaging (MRI).
Are there different types of spinal stenosis?
Lumbar spinal stenosis can be central, lateral, or foraminal, with central stenosis commonly associated with axial back pain, neurogenic claudication, and possible motor or sensory radicular symptoms. The pain associated with central canal stenosis is typically bilateral, and the lumbar levels most commonly involved are at L4–5 level followed by L3–4 and L5–S1.
Lateral recess and foraminal stenosis may be unilateral (one sided) and cause impingement of the traversing or exiting nerve root at the subarticular recess and the foramen, respectively. In lateral recess stenosis, the traversing segment of the nerve root is compressed or irritated by the enlarged facet joint and subarticular ligament hypertrophy. Foraminal stenosis, on the other hand, can be caused by lateral or foraminal disc, or synovial cyst and can impact the nerve or the sensory ganglion. Foraminal stenosis results in a unilateral radiculopathy (radicular pain, diminished relfex and weakness) with pain.
What are the treatment options for spinal stenosis?
The treatment options of lumbar spinal stenosis varies widely in clinical practice and may include either surgical or non-surgical interventions such as medication, bracing, exercise and physical therapy, transcutaneous electrical nerve stimulation (TENS), epidural steroid injections (ESIs), or surgical decompression.
Non-surgical management for lumbar spinal stenosis usually involves some combination of core strengthening, flexibility training, and strengthening exercises.
For patients who do not improve with conservative management or who have severe neurological and pain symptoms and thecal sac compression at presentation, surgical intervention is generally recommended. A systematic review of the literature has shown that delaying surgery for a period of conservative management is not associated with a worse surgical outcome and that surgery is more effective than continued conservative treatment when conservative options have failed for a period of three to six months.
What treatment options do the physios at Sydney Muscle & Joint Clinic offer for spinal stenosis?
The physiotherapists and exercise physiologists at Sydney Muscle & Joint Clinic Penrith use guideline based, research supported interventions in the management of lumbar spinal stenosis.
Non-surgical modalities remain the first-line interventions for patients with lumbar spinal stenosis. Passive techniques suchs a joint mobilisations and soft tissue work may be used to reduce pain, but it the active techniques which will yield the most therapeutic benefit. These include flexion based McKenzie Method repeated movements, joint mobility work with specific directional preference, and trunk and glut muscle strengthening.