Lumbar Stenosis

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KEY POINTS

• Lumbar stenosis is a narrowing in the lower part of your spine that surrounds and protects your spinal cord. The narrowing can irritate or damage the spinal cord.
• Treatment may include physical therapy, medicines, or surgery.
• To put less strain on your back, you can exercise daily, practice good posture, lift properly, and lose weight if you are overweight.

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What is lumbar stenosis?

Lumbar stenosis is a narrowing in the lower part of the spinal canal. The spinal canal is the hollow space in the bones of your spine that surrounds and protects your spinal cord. Your spinal cord is a bundle of nerves that sends messages back and forth between your brain and the rest of your body. The narrowing can squeeze your spinal cord, causing irritation or damage to the spinal cord.

What is the cause?

The most common cause of lumbar stenosis is arthritis of the spine. Over time, the disks that cushion the bones of the spine dry out, causing part of the disk to push out of place and press on the spinal cord. The bones respond to the stress by building extra bone called spurs. The bones and ligaments of the spine shift out of place, which makes the space for the spinal cord smaller. This puts pressure on the nerves that branch off the spinal cord.

Other possible causes are:

• Other bone diseases
• Cancer in the spine
• Fracture of the spine
• A very narrow spinal canal at birth

What are the symptoms?

Symptoms may include:

• Back pain
• Pain in one or both legs
• Numbness or tingling in the legs or feet
• Weakness when you stand or walk
• Problems with bowel or bladder control

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests of the spine may include:

• X-rays
• CT scan, which uses X-rays and a computer to show detailed pictures of the spinal cord and the tissues around it
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the spinal cord and tissues around it

How is it treated?

Depending on the severity of the lumbar stenosis, there are different treatment options. Physical therapy is one of the first choices for treatment. A program of exercises can help strengthen the muscles of your lower back. Your provider may prescribe:

• Medicine
• A shot of steroid medicine to lessen swelling and irritation in your back
• A brace

If these treatments are not helpful, you may need surgery. The most common surgery is called a lumbar laminectomy. The surgery removes tissue that is causing the narrowing. This relieves pressure on the nerves.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• Try sleeping on a firmer mattress.
• Put an ice pack, gel pack, or package of frozen vegetables, wrapped in a cloth on the painful area every 3 to 4 hours for up to 20 minutes at a time.
• Take an anti-inflammatory medicine, such as ibuprofen, or other medicine as directed by your healthcare provider. Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take this medicine for more than 10 days.
• Put moist heat on the sore area for 10 to 15 minutes before you do warm-up and stretching exercises. Moist heat may help relax your muscles. Moist heat includes heat patches or moist heating pads that you can buy at most drugstores, a warm wet washcloth, or a hot shower. Put a hot water bottle or electric heating pad on your back. Cover the hot water bottle with a towel or set the heating pad on low. To prevent burns to your skin, follow directions on the package and do not lie on any type of hot pad. Don’t use heat if you have swelling.

Ask your healthcare provider:

• How and when you will get your test results
• How long it will take to recover from this condition
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent lumbar stenosis?

Here are some of the things you can do so there is less strain on your back:

• Keep your abdominal and back muscles strong. Get some exercise every day and include stretching and warm-up exercises suggested by your provider or physical therapist. Practice good posture.
  • Stand with your head up, shoulders straight, chest forward, weight balanced evenly on both feet, and pelvis tucked in.
  • Whenever you sit, sit in a straight-backed chair and hold your spine against the back of the chair.
  • Use a footrest for one foot when you stand or sit in one spot for a long time. This keeps your back straight.
• Protect your back.
  • When you need to move a heavy object, don't face the object and push with your arms. Turn around and use your back to push backwards so the strain is taken by your legs.
  • When you lift a heavy object, bend your knees and hips and keep your back straight. If you do a lot of heavy lifting, wear a belt designed to support your back. Avoid lifting heavy objects higher than your waist.
  • Carry packages close to your body, with your arms bent.
  • Lie on your side with your knees bent when you sleep or rest. It may help to put a pillow between your knees. Put a pillow under your knees when you sleep on your back. You may need to avoid sleeping on your stomach.
• Lose weight if you are overweight. This takes pressure off your spine.