Lumbar Canal Stenosis

Early lumbar spinal stenosis may have no symptoms. In most people, symptoms develop gradually over time. Symptoms may include:

• Pain in the back
• Burning pain travelling to the buttocks and down the legs (sciatica)
• Numbness, tingling, cramping, or weakness in the legs
• Loss of sensation in the feet
• A weakness in a foot that causes the foot to slap down when walking “foot drop”
• Loss of sexual ability

Pressure on nerves in the lumbar region can also cause more severe symptoms known as cauda equine syndrome. If you have any of these symptoms, please seek urgent medical attention:

• Loss of bowel or bladder control
• Severe or increasing numbness between your legs, inner thighs, and back of the legs
• Severe pain and weakness that spreads into one or both legs, making it hard to walk or get out of a chair

The most common cause of spinal stenosis is osteoarthritis, the gradual wear and tear that happens to your joints over time. That is why most people who develop symptoms of spinal stenosis are 50 or older. Women have a higher risk of developing spinal stenosis than men.

Besides osteoarthritis, other conditions or circumstances that can cause spinal stenosis include:

• Narrow spinal canal
• Injury to the spine
• Spinal tumour
• Certain bone diseases
• Past surgery of the spine
• Rheumatoid arthritis

To diagnose lumbar spinal stenosis, Dr Shiva will ask you questions about your symptoms and perform a physical exam. During the physical exam, Dr Shiva will look for signs of spinal stenosis, such as loss of sensation, weakness, and abnormal reflexes.

Additional tests may be required to diagnose, including:

• X-rays of your lumbar spine. These may show bone growths called spurs that push on spinal nerves or narrowing of the spinal canal.
• Imaging tests. A CT or MRI scan can provide a detailed look at the spinal canal and nerve structures.
• Other studies. Dr Shiva may order a bone scan, myelogram (a CT scan taken after injecting dye), and EMG (an electrical test of muscle activity).

Dr Shiva will likely suggest nonsurgical treatment first unless you have the following:

• Symptoms that prevent walking
• Issues with bowel or bladder function
• Problems with your nervous system

Dr Shiva will consider many factors in deciding if surgery is right for you. These include:

• The success of nonsurgical treatments
• The extent of the pain
• Your preferences

The two main surgical procedures to treat lumbar spinal stenosis are laminectomy and spinal fusion.

• Laminectomy: involves the removal of the bone, bone spurs, and ligaments that compress the nerves.
• Spinal fusion: in this procedure, two or more vertebrae are permanently fused.

Postoperative care

• No lifting more than 5kg, no bending or twisting for six weeks
• No driving for two weeks
• Keep the wound dry for five days. You can get wet in the shower, but pat the area dry rather than rub.
• GP review postoperatively for wound review on day seven
• Monitor for any wound redness, discharge or fevers
• Monitor for new symptoms, including worsening back or neck pain, arm or leg pain, pins and needles or numbness
• Six-week review with Dr Shiva