Lumbar Spinal Stenosis

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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

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What is Lumbar Spinal Stenosis?

Lumbar spinal stenosis is a spinal condition commonly found in older adults, characterised by the narrowing of the spinal canal in the lower back, specifically in the lumbar region. This condition primarily arises from structural changes in the spine that reduce the space within the spinal canal.

As the spinal canal becomes constricted, it places pressure on the spinal cord and nerves, resulting in various symptoms that may affect mobility and quality of life​​.

Causes of Lumbar Spinal Stenosis

Lumbar spinal stenosis develops due to several factors that contribute to the narrowing of the spinal canal in the lumbar region.

  • Age-Related Degeneration
    The most common cause is age-related wear and tear. With age, the intervertebral discs, which cushion the spinal vertebrae, tend to dehydrate and shrink. This can lead to the collapse of facet joints, the thickening of ligaments, and the development of bone spurs, which may intrude into the spinal canal and potentially cause stenosis.
  • Degenerative Disc Disease
    This involves the wear and tear associated with the discs between the vertebrae. As these discs deteriorate, they lose their ability to maintain normal spacing in the spine, contributing to canal narrowing.
  • Herniated Discs
    This condition occurs when the inner, gel-like material of a spinal disc protrudes outward, potentially impinging on the spinal canal or nerve roots.
  • Congenital Predisposition
    In some cases, individuals may be born with a naturally narrower spinal canal, predisposing them to this condition.
  • Spinal Trauma
    Injuries to the lumbar spine, such as fractures or dislocations, can also contribute to spinal stenosis by causing structural abnormalities.
  • Certain Medical Conditions
    Certain conditions like Paget’s disease and achondroplasia can lead to abnormal bone growth and spinal canal narrowing​​.

Symptoms and Signs

Lumbar spinal stenosis has several symptoms, many of which are associated with the pressure exerted on the spinal cord and nerves from the narrowing of the spinal canal.


  • Chronic Back Pain: This pain is typically exacerbated by activities like standing or walking for extended periods.
  • Sciatica: This involves sharp, shooting pain that travels down one or both legs, commonly triggered by prolonged standing or walking.
  • Numbness and Tingling Sensations: Individuals may experience a “pins and needles” feeling or numbness in their lower extremities, indicating nerve compression.
  • Muscle Weakness: Weakness in the legs can make everyday tasks challenging and affect balance and coordination.
  • Bowel or Bladder Dysfunction: In advanced cases, lumbar spinal stenosis may lead to bowel or bladder dysfunction, which requires immediate medical attention​​.

Diagnosis

Diagnosis of lumbar spinal stenosis involves several steps:

  • Medical History Review: A detailed examination of the patient’s medical history is conducted, focusing on symptom onset, duration, factors that worsen or alleviate symptoms, and any relevant medical background.
  • Physical Examination: This includes assessing neurological function, muscle strength, reflexes, and mobility to detect signs of nerve compression or muscle weakness. Limitations in activities like walking, standing, and sitting may also be examined.
  • Imaging Studies: X-rays can be used to evaluate spinal alignment and the presence of bone spurs. An MRI may be employed to provide detailed visualisation of the spinal cord and nerve roots. A CT scan may also be used to identify bone abnormalities and severe cases of stenosis.
  • Diagnostic Injections: In some instances, injections may be used to pinpoint pain sources and assess treatment potential.

Non-Surgical Treatment Options

Various non-surgical treatment options are available for lumbar spinal stenosis, aimed at alleviating symptoms and improving quality of life.

Physical Therapy

Tailored exercise programs are designed to enhance flexibility, strengthen core muscles, and improve posture. These exercises can reduce pain and increase mobility.

Pain Management

Non-prescription pain relievers (e.g., NSAIDs) or prescription medications may be used for pain and inflammation control. Antidepressants and anti-seizure drugs can also be effective for chronic pain and nerve damage.

Lifestyle Modifications

The spine specialist may suggest modifying activities that exacerbate symptoms, such as limiting prolonged standing or walking. Assistive devices like canes or walkers can also be used to aid stability and alleviate symptoms.

Epidural Steroid Injections

These injections can provide temporary relief by reducing inflammation and pain around the affected nerves. They should be used with caution, due to their potential side effects and limitations.

Surgical Treatment Options

In cases where non-surgical treatments are insufficient or for more severe cases, surgical options can be considered.

Laminectomy

This procedure involves removing a portion of the vertebrae, specifically the lamina, to create more space within the spinal canal. This can help relieve pressure on the nerves. It is often considered for more severe cases of stenosis.

Laminotomy

Similar to a laminectomy, but involves a smaller removal of the lamina. This procedure is typically considered for less severe cases of stenosis, where only a portion of the lamina needs to be removed to relieve pressure.

Foraminotomy

This surgery enlarges the openings (foramina) where nerve roots exit the spinal canal. By doing so, it reduces the compression on the nerves, alleviating pain and other symptoms.

Spinal Fusion

In instances of spinal instability, fusion surgery may be performed to stabilise the affected segment of the spine. This procedure often involves the use of hardware such as screws and rods.

Endoscopic Procedures

Minimally invasive techniques like endoscopic surgery involve smaller incisions, which can reduce tissue damage and hasten recovery time. Procedures such as endoscopic foraminotomy or endoscopic decompression are options under this category.

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Prevention Strategies

While lumbar spinal stenosis cannot always be entirely prevented, adopting certain strategies can help reduce the risk and slow its progression.

  • Maintaining a Healthy Lifestyle - Engaging in regular exercise can strengthen the back and core muscles, offering support to the spine. This also includes maintaining a healthy weight, as excess weight can increase stress on the lower back.
  • Avoiding Smoking - Smoking can contribute to disc degeneration, so avoiding it can be beneficial for spinal health.
  • Maintaining Good Posture and Ergonomics - Practicing proper posture and ergonomics, especially when sitting and lifting, can mitigate strain on the spine.
  • Managing Underlying Conditions - Identify and manage underlying conditions that may contribute to stenosis, such as osteoarthritis. This can help reduce the risk of developing lumbar spinal stenosis.
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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.

  • Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
  • Member, Royal College of Surgeons of Edinburgh (MRCSEd)
  • Master of Medicine (Orthopaedic Surgery), National University of Singapore
  • Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
  • Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany

 

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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
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    Mount Elizabeth Novena Specialist Centre
    38 Irrawaddy Road, #08-62/63
    Singapore 329563

    Frequently Asked Questions (FAQ)

    Can I Engage in Physical Activities with Lumbar Spinal Stenosis?

    It is generally possible to engage in physical activities, especially low-impact exercises. Activities that exacerbate symptoms should be avoided. Consult with a spine specialist for guidance on safe exercises, tailored to individual needs.

    Can Lumbar Spinal Stenosis Recur After Treatment?

    Lumbar spinal stenosis can recur, particularly if the underlying causes persist. Ongoing management, including physical therapy and lifestyle modifications, can help prevent these risks. Regular consultations with a spine specialist can help in monitoring and managing the condition effectively.

    How Should I Sit with Lumbar Spinal Stenosis?

    When sitting, use a chair that supports the natural curve of the spine. Keeping knees at hip level or slightly higher can reduce pressure on the lumbar region. Using a lumbar cushion for additional support can also be beneficial.

    What Happens if Lumbar Spinal Stenosis is Left Untreated?

    Leaving lumbar spinal stenosis untreated may lead to the worsening of symptoms, decreased mobility, and potential complications like severe nerve damage. Seeking early diagnosis and treatment from a spine specialist can help manage symptoms effectively and maintain quality of life.