Lumbar Spinal Stenosis | An Overview From Bournemouth Chiropractors at Charminster Chiropractic Clinic

Lumbar spinal stenosis is a degenerative condition that involves the narrowing of the spinal canal in the lower back, leading to compression of the spinal cord and surrounding nerve roots. It is primarily caused by age-related changes in the spine, such as osteoarthritis and herniated discs, but can also be influenced by genetics, previous spine injuries, or congenital abnormalities.

Symptoms of lumbar spinal stenosis can vary but commonly include lower back pain, leg pain, numbness or tingling, weakness in the legs, and difficulty walking. While the condition typically develops gradually, certain symptoms, such as loss of bowel or bladder control or progressive weakness in both legs, require urgent medical attention; call A&E immediately if you are experiencing these symptoms!

Diagnosis involves a thorough evaluation, including medical history, physical examination and requires imaging tests to confirm the condition. There is no cure for lumbar spinal stenosis and, therefore, treatment is only aimed to provide symptom relief. The options are chiropractic treatment, physical therapy or surgical intervention in very severe cases.

With symptom management individuals with lumbar spinal stenosis may experience some pain relief and better quality of life. It is essential for individuals experiencing symptoms or at risk to consult with us at Charminster Chiropractic Clinic or with your doctor for a comprehensive evaluation, referral or personalised symptom management plan.

What is it?

Lumbar spinal stenosis is a degenerative condition that affects the spine, specifically involving the narrowing of the spinal canal in the lower back. This narrowing can compress the spinal cord and nerve roots that pass through the lumbar spine, leading to various symptoms and functional impairments. The condition typically develops gradually over time as a result of age-related changes in the spine, although it can also be influenced by genetic factors, previous spine injuries, or congenital abnormalities. The progression of lumbar spinal stenosis varies among individuals but generally involves a gradual narrowing of the spinal canal and worsening of symptoms over time.

• Osteoarthritis: Osteoarthritis is wear and tear (degeneration) of the cartilage between the facet joints of the spine that can lead to the growth of bone spurs (osteophytes), which have the ability to squeeze or push on the spinal canal and compress nerve structures.
• Herniated discs: The discs that act as cushions between the vertebrae may bulge or become herniated, protruding into the spinal canal and causing narrowing.
• Thickened ligaments: Ligaments that support the spine may thicken over time, contributing to the narrowing of the spinal canal.
• Spinal injuries: Previous injuries to the spine, such as fractures or dislocations, can make it more likely for individuals to developing spinal stenosis later in life.
• Congenital factors: Some individuals may be born with a narrow spinal canal or structural abnormalities in the spine that increase the risk of developing spinal stenosis.

Common Causes

The primary cause of lumbar spinal stenosis is wear and tear (degenerative) changes in the spine associated with ageing. Understanding these underlying causes is crucial for diagnosing lumbar spinal stenosis and developing appropriate management plans.

• Osteoarthritis: The most common cause of lumbar spinal stenosis, osteoarthritis leads to the breakdown of cartilage and the formation of bone spurs, which can encroach upon the spinal canal.
• Degenerative disc disease: Changes in the spinal discs, such as loss of disc height or herniation, can contribute to narrowing of the spinal canal.
• Thickening of ligaments: Ligaments that support the spine may thicken over time, further narrowing the spinal canal and compressing nerves.
• Spondylolisthesis: This condition occurs when one vertebra slips forward over another, potentially narrowing the spinal canal.
• Trauma or injury: Previous spine injuries, such as fractures or dislocations, can lead to structural changes that predispose individuals to developing spinal stenosis later in life.
• Genetic factors: Some individuals may have a genetic predisposition to developing conditions like osteoarthritis or structural abnormalities in the spine that increase the risk of spinal stenosis.

Common Symptoms

The symptoms of lumbar spinal stenosis can vary widely depending on the severity of the spinal canal narrowing and the degree of nerve compression. These symptoms typically develop gradually and may be mild at first but can worsen over time if left untreated.

• Lower back pain: Pain in the lower back is a common symptom of lumbar spinal stenosis. The pain may be dull or sharp and often radiates to the buttocks and thighs.
• Leg pain (sciatica): Compression of the nerves in the lower back can cause pain, numbness, tingling, or weakness in one or both legs. This pain may worsen with walking or prolonged standing and may be relieved by sitting or bending forward.
• Numbness or tingling: Patients may experience sensations of numbness or tingling in the legs or feet, which can come on sometimes or constantly.
• Weakness: Weakness in the legs or difficulty lifting the legs may occur due to nerve compression in the low back (lumbar spine).
• Difficulty walking: Many individuals with lumbar spinal stenosis experience difficulty standing upright, walking or maintaining balance, particularly during long periods of standing or walking downhill. Some may also experience claudication, a condition where pain or cramping occurs in the legs during physical activity and improves with rest.

When to Seek Urgent Help

While lumbar spinal stenosis generally progresses slowly, certain symptoms may indicate a medical emergency and require immediate evaluation in the hospital. If you experience any of these symptoms, it is essential to seek urgent medical care to ensure timely diagnosis and appropriate treatment.

• Loss of bowel or bladder control: This may indicate compression of the cauda equina nerves in the lower spine, a condition known as cauda equina syndrome, which requires urgent surgical intervention to prevent permanent nerve damage.
• Progressive weakness in both legs: Weakness that worsens over time may indicate significant nerve compression and should be evaluated promptly to prevent long-term complications.
• Sudden, severe back pain: Acute onset of severe back pain, tingling down both legs and numbness in genital area and down both legs may indicate a more serious underlying condition, such as a severe herniated disc or spinal fracture, requiring immediate medical attention.

Risk Factors

Several factors may increase the risk of developing lumbar spinal stenosis. While these risk factors may increase the likelihood of developing lumbar spinal stenosis, it is essential to note that not everyone with these risk factors will develop the condition, and individuals without these risk factors may still develop spinal stenosis.

• Age: The risk of developing spinal stenosis increases with age, as degenerative changes in the spine become more common.
• Previous spine injuries: Trauma to the spine, such as fractures, dislocations, or previous surgeries, can predispose individuals to developing spinal stenosis later in life.
• Genetics: Some individuals may have a genetic predisposition to developing conditions such as osteoarthritis or structural abnormalities in the spine that contribute to the development of spinal stenosis.
• Occupations or activities: Jobs or activities that involve repetitive spinal movements, heavy lifting, or prolonged sitting or standing may increase the risk of developing lumbar spinal stenosis.
• Obesity: Excess weight can put additional stress on the spine and increase the risk of developing spinal stenosis.
• Smoking: Tobacco use can impair blood flow to the spine and accelerate degenerative changes in the spine, potentially increasing the risk of developing spinal stenosis.

Examination and Diagnosis

Diagnosing lumbar spinal stenosis typically involves a comprehensive evaluation by a healthcare professional and imaging to confirm the findings. In some cases, additional diagnostic tests such as electromyography (EMG) or nerve conduction studies may be performed to evaluate nerve function and identify specific nerves affected by spinal stenosis. Once a diagnosis of lumbar spinal stenosis is confirmed, the healthcare provider can develop an appropriate management plan tailored to your individual needs and preferences.

• Medical history: The healthcare provider will review your symptoms, medical history, and any previous spine-related injuries or surgeries.
• Physical examination: A physical examination may be performed to assess your functions, range of motion, muscle strength, reflexes, and sensation in the affected areas.
• Imaging tests: Imaging studies, such as X-rays, MRI (magnetic resonance imaging), or CT (computed tomography) scans, may be ordered to visualise the spinal structures and confirm the diagnosis of lumbar spinal stenosis. These imaging tests can help identify the location and severity of the narrowing of the spinal canal and assess the extent of nerve compression.

Pain Management

Managing pain with lumbar spinal stenosis focuses on releasing muscle and joint tensions, improving spinal alignment and alleviating symptoms through lifestyle and ergonomics changes. 

• Traction: Traction therapy may be used to gently stretch the spine and decompress the spinal discs, reducing pressure on the nerves and reduce symptoms.
• Exercise therapy: Chiropractors may prescribe specific exercises to improve spinal flexibility, strengthen supporting muscles, and improve posture. These exercises can help alleviate symptoms of lumbar spinal stenosis.
• Ergonomic advice: Chiropractors can provide guidance on proper body mechanics and ergonomic principles to reduce strain on the spine during daily activities, such as lifting, bending, and sitting.

Prognosis

The prognosis for individuals with lumbar spinal stenosis varies depending on several factors, including the severity of the condition and individual factors such as age and overall health. While it is very important to aknowledge there is no cure for lumbar spinal stenosis and it is a chronic condition that typically worsens over time. However, appropriate management and lifestyle modifications may help manage symptoms and may improve quality of life.

Conservative treatments such as chiropractic treatment, physiotherapy, and medication may provide some relief for individuals with lumbar spinal stenosis. However, in more severe cases or when conservative treatments are ineffective, surgical intervention may be necessary to relieve pressure on the spinal cord and nerves.

Regular follow-up appointments with your healthcare provider are essential to monitor your condition, track your progress, and alter your treatment plan as needed. Some individuals with lumbar spinal stenosis may still maintain an active lifestyle and experience better mobility and reduced pain.

References

1. https://www.ncbi.nlm.nih.gov/books/NBK546618/
2. https://pubmed.ncbi.nlm.nih.gov/8169540/
3. https://pubmed.ncbi.nlm.nih.gov/9467101/
4. https://www.ncbi.nlm.nih.gov/books/NBK441822/
5. https://www.ncbi.nlm.nih.gov/books/NBK441971/
6. https://pubmed.ncbi.nlm.nih.gov/24614255/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411405/
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10423346/
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8246101/
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788378/
11. https://pubmed.ncbi.nlm.nih.gov/24572195/