The vertebrae are the bones that make up the lumbar spine (low back). The spinal canal runs through the vertebrae and contains the
nerves supplying sensation and strength to the legs. Between the vertebrae are the intervertebral discs and the spinal facet joints
into the spinal canal. The bones and ligaments of the spinal facet joints can thicken and enlarge, due to arthritis, also pushing into the
spinal canal. These changes cause narrowing of the lumbar spinal canal which is known as spinal stenosis (figure).
stenosis narrows the spinal canal.
Spinal stenosis does not necessarily cause symptoms. Many people can have significant stenosis on imaging studies but fail to have
symptoms.
occur. Rarely, bowel and/or bladder problems can occur.
Bending forward or sitting increases the room in the spinal canal and may lead to reduced pain or completed relief from pain.
Your physician will take a history and perform a physical examination.
study may be obtained for a more detailed evaluation of spinal structures. Or, a computed axial tomography (CAT) scan and/or a
lumbar myelogram may be advised for similar improved detail.
pressure.
If your doctor determines that lumbar spinal stenosis is causing your pain, he or she will usually try nonsurgical treatments at first.
to control pain for temporary reduction in pain.
more normal lifestyle.
Symptoms of spinal stenosis frequently result in activity avoidance. This results in reduced flexibility, strength and cardiovascular
endurance. A exercise program usually begins with stretching exercises to restore flexibility to tight muscles. You may be advised to
stretch frequently to maintain flexibility gains. Cardiovascular (aerobic) exercise, such as stationary bicycling or walking on a treadmill,
may be added to build endurance and improve circulation to the nerves. Improved blood supply to the nerves may alleviate the
symptoms of spinal stenosis.
less challenging if flexibility, strength and endurance are optimized. Your therapist and physician may advise you on how best to
incorporate a maintenance exercise program into your life, either at home using simple equipment, or at a fitness facility.
moved to a more convenient location. A bedside commode may be advisable. Bathroom safety devices are prescribed if needed.
Strategies for preparing meals, pacing activities and conserving energy may be reviewed. Optimal fitting of assistive walking devices
such as canes and walkers may be recommended.
itself usually does not represent a dangerous condition in the adult, Therefore, treatment is aimed at pain reduction and increasing the
patient's ability to function.
improved life function without requiring more invasive treatment. A comprehensive program may require three or more months of
supervised treatment.
Surgery is reserved for that small percentage of patients whose pain cannot be relieved by nonsurgical treatment methods. Surgery
will also be advised for those individuals who develop progressive leg weakness, or bowel and bladder problems.
for the nerves. This is called lumbar decompression surgery, or laminectomy.
activities within weeks. Postoperative rehabilitation may be advised to assist in return to normal activities.
may then occur between the vertebrae. In such cases, spinal fusion surgery may be required in addition to decompression in order to
stabilize the involved vertebrae.
American Spine Society patient education brochure on Fusion for more information.) Fusion can be performed from the front (anterior
approach) or from the back (posterior approach), or may require both anterior and posterior approach. The choice of approach is
influenced by many technical factors including the need for spur removal, anatomic variation between patients, and degree of
instability. The success rate of fusion surgery is over 65%.
months. A postoperative rehabilitation program is usually prescribed to guide return to activities and normal life.