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Lumbar spinal stenosis is the narrowing of the lumbar spinal canal, compressing the nerves that travel though the lower back to the legs. It can affect one or more lumbar levels, the most frequent being L4-L5, followed in descending order of frequency by L3-L4, L2-L3, L5-S1 and L1-L2.
Lumbar spinal stenosis can be either congenital or acquired. Below, we offer a description of both types in more detail:
Consists of a shortening of the pedicles that causes a narrowing of the anteroposterior diameter of the lumbar canal, as well as the exit point of the nerve roots.
Appears as a result of degenerative changes:
In patients with congenital lumbar spinal stenosis, symptoms that affect their quality of life may appear prematurely, between 30 and 50 years of age, while patients with acquired lumbar spinal stenosis usually develop symptoms after the age of 60.
The symptoms of lumbar spinal stenosis are listed here in order of frequency:
To diagnose correctly whether a patient has lumbar spinal stenosis, image tests are needed in addition to the presence of symptoms typical of the disease:
Helps determine if there is any bone abnormality, the type of curvature and whether or not there is instability of the lumbar spine.
Is the preferred test for the diagnosis of spinal stenosis, since it provides information about bone structures (not as defined as CT) and soft tissue such as the yellow ligament, intervertebral discs, the presence of synovial cysts…
Which gives a good resolution image of the bone structures.
Treatment of lumbar spinal stenosis will depend on the severity of the patient's symptoms. If these are mild, it is possible to carry out a conservative treatment that includes one or more of the following measures.
When patients become less active because of pain, this causes muscle weakness, which in turn, may cause the patient’s pain to increase. Exercises designed to increase the strength and endurance of the vertebral musculature and maintain the flexibility and stability of the spine can have beneficial effects in patients with lumbar spinal stenosis.
Injection of steroids into the space around the nerve can help reduce inflammation and relieve pain.
Surgery is the treatment of choice when other therapies have not been effective or when symptoms are severe. The objective of the surgery is to decompress the area of stenosis and thus release the compressed roots.
There are various types of surgery for this pathology:
This is the standard treatment for lumbar spinal stenosis not associated with spondylolisthesis or degenerative scoliosis. It consists of the extraction of the lamina (posterior part of the vertebra), hypertrophic yellow ligament and osteophytic areas of the facets that are contributing to the narrowing of the spinal canal, in order to free the dural sac and nerve roots.
This is indicated in the cases of patients with unilateral stenosis and unilateral symptoms. In this procedure, the surgeon resects only the lamina on the affected side and the integrity of the interspinous and supraspinatus ligaments is preserved, thus minimizing spinal instability.
This consists of a focal decompression, removing only a portion of the vertebral lamina to release the compressed nerve roots.
This technique consists of widening the lumbar canal by elevating the laminae involved in the stenosis and subsequently placing an autologous bone graft on the surface of the operated levels, in order to maintain the stability of the spine.
May be necessary in cases of lumbar stenosis associated with spondylolisthesis (displacement of one vertebra with respect to another), in which laminectomy can increase spinal instability.
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