Lumbar Canal Stenosis

INTRODUCTION

Lumbar canal stenosis is a condition where the channel running through the lower part of the spine (lumbar canal) becomes excessively narrowed (stenosis). Stenosis is due mainly to degenerative wear-and-tear, over many years, causing a thickening of the various bones, joints and ligaments that form the spinal canal. Degenerative changes are normal in adult life. They are more likely to cause the symptoms of lumbar canal stenosis, however, in someone who is born with a smaller than average lumbar canal. The narrowing usually affects one or two vertebrae, and sometimes can involve up to five “levels” in the lumbar spine

CAUSES:

  •  Arthritis
  • falls
  • accidents
  • wear and tear on the spine’s bones and joints

SYMPTOMS

The usual symptoms of lumbar canal stenosis are a combination of back pain and symptoms in the legs. The symptoms in the legs indicate that there is pressure on the spinal nerves as they pass through the point(s) of narrowing in the lumbar spine, resulting in either sciatica (sharp pains shooting down the back of one or both legs), or claudication (heavy, dull aching, with pins and needles in the feet and legs brought on by standing or walking). Your legs might also feel cramped, tired or weak. These symptoms usually start when you are standing or walking. Often, the symptoms get better if you sit, crouch or lie in the fetal position (on your side with your knees tucked up to your chest). It’s thought that these positions “open” the lumbar canal and take the pressure off the nerves that go to the legs.

In severe cases, stenosis can cause partial or complete bowel or bladder incontinence.

DIAGNOSIS

The diagnosis can be made with a CT scan or MRI scan of the lumbar spine.

An MRI scan is a simple and safe test, similar in many ways to a CT scan. MRI use a technique known as magnetic resonance imaging. No radiation is involved. There is no need to be admitted to hospital and usually no need for injections, although people prone to claustrophobia may find the examination stressful and should discuss their anxiety with medical staff at the time of the test. People with heart pacemakers cannot have an MRI.

COMPLICATIONS:

Serious complications are rare and the risk of death is remote. As with any operation, there may be general complications related to age and underlying disease. A 75-year-old with diabetes and heart disease has a greater risk of complications than, for example, a 40-year-old in perfect health. General complications can include stroke, heart attack, bleeding in the wound post-operatively, blood clots in the legs (which can travel to the lungs or heart) and infection.

Possible complications specific to a laminectomy for lumbar canal stenosis include damage to one or more of the nerves travelling through the spinal canal, which could cause permanent numbness or weakness in the legs or feet (or to some part of either leg) and, on rare occasions, affect control of the bladder or bowel.

TREATMENT

Prior to surgery, you may be taken to x-ray for a ‘marker’. The radiologist places a small mark over the problem area in the spine, usually involving a minor injection just into the skin.

During the operation, the surgeon opens the spinal canal. This immediately relieves the pressure caused by the narrowing. Except in unusual and particular circumstances, a laminectomy does not weaken the structural stability of the spine. The surgery is performed using a variety of fine tools, but much of the work is performed with a very sophisticated and delicate drill, which very gradually whittles away the bone. On average, the operation takes about two hours. If more levels than usual are involved, then the operation takes longer.The main reasons for surgery are to relieve the symptoms in your legs and preserve your ability to walk. Surgery is performed on the back, to treat the legs. Surgeons do not usually perform a laminectomy to relieve back pain.

PREVENTION:

For six weeks when you get home, the most important thing to do is rest. Your wound needs time to heal, internally as well as externally. Avoid undue bending and lifting. Minimise sitting to essentials such as eating and toileting. It is advisable to avoid driving, and even sitting as a passenger, in a car.

Schedule two good walks of about 15 minutes each per day. Swimming is excellent exercise after spinal surgery but you should wait to begin until after your post-operative review, which is usually six weeks after surgery.

In most cases, the symptoms caused by the disc prolapse will have eased within six weeks of surgery but this varies greatly from person to person.

At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:

  •  Pain relief
  • Muscle strengthening
  • Traction
  • Positioning
  • Correction of posture
  • Prescription of splint

 

VISIT PHYSIOLINE FOR FURTHER CONSULTATION AND TREATMENT