Sebastian Lattuga M.D. provides patient education materials on Lumbar Spinal Stenosis. *What is lumbar spinal stenosis? *What are the symptoms of lumbar spinal stenosis? *Non-surgical treatment *Surgical treatment *Living with lumbar spinal stenosis

1. +
Lumbar Spinal Stenosis
New York Spinal Specialists
© 2012 SpineSearch LLC
Design BRAVA Creative

2. + What is lumbar spinal stenosis?
 Spinal stenosis is a narrowing of the spinal canal. The
spinal canal runs down the center of your spine and
surrounds the spinal cord.
 The word “stenosis” means “narrowing of a bodily canal
or passageway.” Some people are born with spinal
stenosis, but most often, it occurs as a result of aging or
wear and tear on the spine.
 Conditions such as osteoarthritis and degenerative disc
disease can cause an overgrowth of bone and soft tissue
in the spine. This “overcrowding” reduces the space in
the spinal canal and prevents the spinal cord and nerves
from functioning normally.
Lumbar spinal stenosis
 Other causes of stenosis include bone spurs, tumors, is a common cause of
previous surgery and trauma. back and leg pain.
 Spinal stenosis can occur anywhere along the spine, but
the cervical (neck) and lumbar (lower back) regions are
most commonly affected.
Patient Education

3. + Are there different types of stenosis?
Stenosis is frequently classified by its location. Learning a few
basics about spinal anatomy can help you better understand
your condition and make informed treatment decisions.
Foraminal stenosis occurs when the foramen (opening) through
which the nerves branching off the spinal cord exit the canal is Spinal stenosis is most
obstructed. Each vertebra has 2 foramina, one on each side. commonly caused by
osteoarthritis and
Lateral stenosis indicates that the nerve is being compressed at
degenerative disc
the point of exit through the lateral (side) foramen. Far lateral
disease.
stenosis means that the nerve is affected after it passes through
the lateral foramen.
Central stenosis refers to compression that occurs in the spinal
canal. This type of stenosis is usually caused by a bulging or
herniated disc.
Patient Education

4. + What are the symptoms of lumbar spinal stenosis?
 Lower back pain – can range from mild to severe
 Sciatica – often described as burning pain that starts in the
buttocks and runs down the leg/s
 Numbness, tingling, or an ache in the buttocks or leg/s
 Leg fatigue/weakness, pins and needles sensation
 Foot drop – foot seems to slap on the ground when walking
 Pain occurs when walking, standing for long periods, or walking
downhill
 Pain relieved by sitting or leaning forward
 Bowel and bladder problems – rare
Symptoms are caused by compression of the nerves or spinal
cord.
Patient Education

5. + What is neurogenic claudication?
Neurogenic claudication is set of symptoms specific to
lumbar spinal stenosis. Symptoms may be felt in the back,
buttocks or legs (or any combination thereof) and consist
of: Learning to make simple
 Pain adjustments can help you
manage your condition. For
 Weakness
example, if walking for long
 Alterations in sensation, e.g., tingling, pins and needles periods causes painful
 Cramping symptoms, try to plan ahead
for periods of rest.
Neurogenic claudication typically manifests itself when
individuals with lumbar spinal stenosis are walking or
standing for an extended period of time. Symptoms may
be felt on one or both sides of the body.
Patient Education

6. + How is lumbar spinal stenosis diagnosed?
What to expect at the doctors’ office
Truck drivers, heavy equipment The doctor will talk to you about
operators, and construction your medical history and perform a
workers have the highest rate of physical exam. You may be asked
back injuries. when the symptoms began, what
makes the symptoms better or
worse, and what treatments or
surgeries you have had.
During the physical exam, the doctor
will probably check your back, feeling
for painful areas. Your legs will be
examined to see if there are any areas
of weakness or altered sensation. Your
Early diagnosis and treatment ability to sit, stand and walk will be
increase your chances of being able to assessed. Imaging studies are usually
return to your previous level of activity. ordered to confirm the diagnosis.
Patient Education

7. + Tests to confirm a diagnosis of lumbar spinal stenosis
 X-ray – films of the spine can show bone
spurs, disc damage, and abnormal motion
between the vertebrae.
 CT scan – computerized axial tomography is
more advanced than X-ray. It can show
whether or not the nerves in the back are
compressed.
 MRI – the images produced by magnetic MRI is considered the best
resonance imaging allow for precise imaging test for diagnosis of
visualization of the spine and accurate spinal stenosis because it
assessment of the stenosis. produces cross-sectional
(slices) images of the spine.
 EMG – an electromyogram can show which If something is pressing on
the spinal cord or nerves,
nerves have been damaged as a result of
MRI can detect it.
long-term compression.
Patient Education

8. + Non-surgical treatment
Symptoms can sometimes be
managed with non-surgical
treatment such as:
 Medication to reduce inflammation
 Pain medication – prescription or
over the counter drugs
 Cortisone injections
 Physical therapy – often effective
As a general rule, the physician will
first recommend non-surgical
 Lifestyle changes and/or remedies
treatment for relief from painful
e.g., walking aids
symptoms. Lumbar spinal stenosis is a
condition that usually worsens over
time. Response to treatment depends
on many factors.
Patient Education

9. + Surgical treatment
If non-surgical treatment doesn’t work,
surgery is a reasonable next step. The
goal of surgery is to take pressure off
the spinal cord and/or nerve roots.
Decompression surgery, as it called,
means that the surgeon removes or
trims the bone/tissue that is causing
the compression.
If needed, the surgeon may combine a
decompression surgery with a spine
stabilization procedure.
Early diagnosis and treatment increase
your chances of being able to return to Spinal fusion is an example of a
your previous level of activity. stabilization surgery. Vertebrae are
fused together in an attempt to
prevent abnormal movement in the
spinal column.
Patient Education

10. + The most common surgeries to treat
lumbar spinal stenosis
 Decompressive laminectomy – the surgeon
removes part of the vertebra to create more space
for the nerves in the spinal canal. This is a very
common procedure.
 Discectomy – a herniated disc can press on
nearby nerves. With this procedure, the surgeon
may remove all or part of the disc that is causing
problems.
 Spinal fusion – a fusion may or may not be Today, patients have more
combined with other procedures. Vertebrae can be treatment options than ever before.
fused together with metal screws/plates or bone Many surgeries that were once
graft. Surgeons fuse vertebrae together to stop open back procedures can now be
them from moving against each other. Over time, done with minimally invasive
the fused vertebrae bind together and become like techniques.
one.
Patient Education

11. + Minimally invasive surgery
Minimally invasive surgery is done through small
incisions. Surgeons use small, high-tech instruments
and probes with cameras attached. Because the
surgeon operates through a “keyhole,” trauma to the
muscle and tissue in the back is reduced.
Benefits of minimally invasive surgery:
 Less pain
 Shorter hospital stay All surgery has risks and
benefits. Talk to your doctor,
 Faster recovery, less down time ask questions and have realistic
expectations for your surgical
 Smaller scars
outcome.
Patient Education

12. + Living with lumbar spinal stenosis
It’s difficult living with chronic back
and leg pain. Talk to your doctor
about what you can do to manage
your condition. Ask about physical
therapy. Start an exercise
program. Consider alternative
therapies that you might not have
considered before.
Most important, try to maintain a
positive attitude. Living in a
constant state of distress or anger
about your condition doesn’t help. Stay active.
If you feel upset more often than
Stay involved.
not, find the courage to talk about
it with your doctor. Stay hopeful.
LIVE your life.
Patient Education