Lumbar Spinal Stenosis

Ravi Yalamanchili, MD

About 30,000 people in the U.S. suffer from the serious neuromuscular disease known as Lou Gehrig's disease. The vast majority of you have heard of and are familiar with it. However, there are 300,000 to 500,000 people in the U.S. who have a neurosurgical illness which most people are unaware of - lumbar spinal stenosis (LSS). If you are over the age of 60, odds are about one in 250 that you are going to know what LSS feels like someday. There's a reason Americans don't know about it: it gets little attention.

The neurosurgical society recently searched a database of more than 5,000 newspapers and magazines for a two and a half-year period. They found almost 12,000 stories on back pain and 1,300 on back surgery - but only a handful on lumbar spinal stenosis. Even many healthcare professionals are not well-informed about this condition, which can cause symptoms similar to several common conditions related to aging. The result is that LSS can often be misdiagnosed or underdiagnosed.

The bad news is that LSS cannot be prevented and its victims cannot be predicted. The condition is progressive - usually getting worse with time, until the pain is chronic. It is an equal opportunity affliction. It strikes men and women equally. It does not distinguish on the base of race or occupation. It is something that just happens to older people as they age. LSS is aggravated by arthritis, obesity, smoking, and certain back problems.

The good news is that effective, proven treatment is available. The real challenge is making people aware of it.

There are actually two types of LSS. A relatively rare form of congenital spinal stenosis strikes younger people, often in their 30s and 40s. This condition is easier to diagnose because younger people don't have the other aches and pains that come with age and make LSS harder to pinpoint in older people.

The more common type of LSS is degenerative and strikes middle and older people. It reflects the normal wear and tear of life on our bodies. Because it comes at a time when we are often struggling with osteoarthritis, lumbar sprains and strains, peripheral vascular disease/circulation problems and other conditions of aging, diagnosing degenerative lumbar spinal stenosis can be a challenge.

There are some common symptoms. These can come and go. They include aching, dull, severe, or burning pain in the lower back that radiates down one or both buttocks or thighs. In some cases, there is pain, numbness, tingling, or weakness in one or both legs. In advanced cases, this can include loss of strength, and in rare cases, even difficulty with bowel or bladder control. Typically, sufferers feel pain when they walk or stand. The pain will initially start after a few minutes of activity. Over time, it can become unbearable to even walk short distances like to the end of the driveway.

For most patients, relief comes when they sit down. This can cause people to become couch potatoes and begin to think they're "just getting old" when, in fact, they are suffering from a treatable condition. A classic sign of LSS is leaning on the shopping cart for support when grocery shopping because a bent posture leaning forward provides relief.

Diagnosing LSS is often challenging, requiring a review of the patient's history, a physical exam, and imaging studies. Diagnosis begins with the patient. That is why it is very important to keep track of your pains and to describe what you're feeling as fully as possible. Next is the physical exam. We look for neurological deficits such as loss of motor strength and/or sensation and reflex changes. Then we decide if an advanced imaging study, such as an MRI, is needed.

Once the diagnosis of LSS has been made, there are several treatment options. For those with mild symptoms, analgesics, muscle relaxants, and anti-inflammatory are frequently recommended to help manage the pain. Frequently, medications are combined with physical therapy, including back exercise, aerobic exercises, and stretching.

If these therapies do not work, or when the disabilities from LSS are severe and chronic, surgery comes the next treatment of choice. Decompressive laminectomy, the procedure most often done for LSS, is the most common back surgery performed on older people today. Neurosurgeons and other specialists performed almost 60,000 of these operations last year. For a large majority of these patients, the results are very good. Eight out of ten reported complete or significant relief of their symptoms.

The surgery is done in the hospital under general anesthesia. Typically, the operation involves work on multiple levels of the lumbar spine. Each of the five lumbar vertebrae constitute a level. The procedure usually takes about two hours to complete. Most patients are walking the evening of their surgery and leave the hospital within two to five days and have totally recovered within six weeks to six months, depending on their condition before the surgery and the severity of the stenosis.

The decision whether to do surgery involves balancing the severity of the condition and the compromises to a person's lifestyle against the risks of surgery. Consideration to neurological problems are addressed. For example, if a patient is having serious or progressive neurologic deficits, surgery is a priority. One issue that is not a critical factor, surprisingly enough, is age. Decompressive surgery has been successfully performed on otherwise healthy patients in their 80s and 90s.

If you take anything away from this article, it should be an increased awareness of lumbar spinal stenosis. It is not a life-threatening disease but a life-limiting one. LSS can reduce the freedom and joy of living. This condition may be unavoidable, but it is not unbeatable. It is totally treatable. If you have symptoms, make a list and tell your doctor about them. Ask for a neurosurgical consultation.