Lumbar spinal stenosis is a narrowing of the central canal of the spinal column that affects approximately 8-11% of individuals in the United States. The most common cause is degenerative changes that occur within the spine including the joints, ligaments and discs. Another common cause of spinal stenosis is called spondylolisthesis. Spondylolisthesis occurs when one vertebrae slips off of the one below it. This causes a narrowing of the spinal canal which can, if severe enough, pinch the nerves as they exit the spine.
Symptoms of spinal stenosis include sciatica, neurogenic claudication (typically manifested by calf pain), and weakness. Most patients who have symptoms complain of not being able to walk as long a distance as they had been previously. Typically once they rest the symptoms improved. Symptoms may be present only with activity, or as the stenosis progresses symptoms may become constant.
Every treatment plan for low back pain should start with a discussion about non-surgical options. Because spinal stenosis is primarily a degenerative condition, it is not likely to resolve on its own with just rest, heat or ice like a sprain would. The first step is usually beginning an exercise program, typically through physical therapy, to strengthen core muscles including the abdominal paraspinal muscles. Maintaining range of motion is also very important. Anti-inflammatory medications may be prescribed along with other medications to relieve pain if needed.
In individuals with ongoing pain uncontrolled with conservative measures or those with muscle weakness, surgery may be needed. There are different procedures, each with their own benefits and risks, but all try to take pressure of the spinal nerves. Even after surgery though these patients should have a rehabilitation consult to help them maximize their improvement and restore function.
Spinal stenosis is a common condition and often requires medical treatment since the degenerative nature of the disease makes it unlikely to resolve on its own. As experts in conservative, non-surgical treatment options, a physiatrist is well suited to help diagnose and treat the pain and dysfunction associated with stenosis.
