Lumbar stenosis: definition, causes, symptoms, diagnosis and treatment

By Cristiano Antonino On Jun 21, 2023

Lumbar stenosis is a narrowing of the vertebral canal in the lumbosacral spine. This disorder can lead to changes in the spine that can generate excessive pressure on the nerve roots, causing intense pain

This condition, in most cases, is acquired and is caused by other medical conditions or diseases present in the patient.

The most common manifestation of stenosis is sciatica which appears, mainly, in older people

In fact, while it is true that with age the canal tends to narrow, making stenosis a paraphysiological process, the changes are more evident in people who carry out strenuous work in the lumbar region or in subjects who are overweight.

The pathology is often related to ageing but can also be due to other medical conditions such as herniated discs, spinal tumours, spondylosis, congenital malformations or Paget’s disease.

In any case, it manifests itself with pain in the lower back region that may radiate to the buttocks and legs, which may also present with numbness, tingling or weakness.

The treatment for this condition may vary depending on the severity of the symptoms and the underlying cause: the doctor will recommend conservative or surgical treatment.

What is lumbar stenosis?

Lumbar stenosis indicates a narrowing of the spinal canal in the lumbosacral section of the spine, resulting in compression of the spinal cord and peripheral nerves in that section.

The most frequently affected intervertebral spaces are the one between the third and fourth and the one between the fourth and fifth lumbar vertebrae.

The least affected tract is that between the fifth lumbar vertebra and the first sacral vertebra.

However, along with cervical stenosis, lumbar stenosis is the most common of all spinal stenoses.

To better understand the extent of the problem, one should understand what the spinal canal is and how it works.

Due to the correct positioning of the vertebrae, a conduit that houses the spinal cord, called the vertebral canal, runs the length of the spinal column.

The spinal cord plays a central role in the human organism because, together with the encephalon, it forms the central nervous system.

What are the symptoms?

The symptoms of lumbar stenosis are quite varied and may even be absent.

Even in the case of symptomatic stenosis, there may be alternating periods of intense symptoms and other periods of apparent well-being; only in some cases is the condition persistent and tends to progressively worsen with time.

Of course, it is always possible that a stenosis, initially asymptomatic, suddenly manifests itself with painful symptoms, even very intense ones.

Let’s see specifically what the symptoms are.

The main symptom is pain in the back, especially in the lumbar region, which may involve the entire spine.

Then there are the symptoms due to nerve root compression, such as:

Numbness and tingling in the buttocks and legs.
Hyposthenia or loss of strength in the lower limbs and so-called ‘drooping foot’.
Reduction of reflexes along the segment affected by the nerve.

Claudicatio neurogena, i.e. pain in the buttocks and legs particularly during physical activity, which is reduced with a 90° body position, i.e. sitting or with the back flexed forward.

Only in some cases is it possible to cause cauda equina syndrome.

In more severe cases of lumbar stenosis, there may also be repercussions on bowel or bladder function, with loss of complete sphincter control.

Obviously, not all symptoms are specific to lumbar stenosis, so it is advisable – should one or more symptoms occur – to contact your doctor who will be able to direct you towards the correct diagnostic and therapeutic course.

Lumbar stenosis is rarely congenital and is usually caused by other pathologies, such as

Osteoarthrosis
Disc degeneration or herniated discs
Spondylolisthesis, or slipping between two contiguous vertebrae
Paget’s disease
Rheumatoid arthritis
Scoliosis of the lumbar spine
Spinal tumours
Hypertrophy of the laminae
Presence of scar tissue from previous surgery

Physiologically, vertebrae undergo a number of structural changes over the years, so lumbar stenosis is a phenomenon that can be physiologically associated with ageing.

In fact, one of the typical changes one witnesses with the passing of the years is the narrowing of the spinal canal, resulting in compression of the spinal cord.

One should not think that one has to become an ultracenarian to witness substantial skeletal changes, in fact, the degeneration of the vertebrae and its components, albeit slowly and unnoticeably, begins from the age of 25.

If advanced age is the main cause of stenosis, the condition is called degenerative lumbar stenosis.

Also risk factors for the development of lumbar stenosis are certain daily life habits, such as smoking, and certain physical conditions, such as diabetes mellitus and obesity.

Diagnosis

A correct diagnosis of lumbar stenosis will require an accurate anamnesis, followed by a thorough objective test and then imaging to confirm the diagnostic suspicion.

In the first part of the examination, therefore, the specialist will ask a series of questions concerning the subject’s health condition, perceived symptoms and daily habits.

The doctor will then perform an objective test, assessing the patient.

The diagnosis, however, cannot be definitive: imaging will be required to confirm the condition.

In particular, the doctor may decide to prescribe an X-ray to judge the overall state of the spine and exclude bone changes.

However, to detect a lobar stenosis, a CT or MRI scan is usually recommended.

In this way, the tissues in the area of interest can be observed in detail.

Thus, possible stenosis and the state of spinal cord involvement can be detected.

A myelography may be prescribed: a kind of X-ray with a contrast medium that allows the spinal cord, nerves and other tissues in the spinal canal to be analysed.

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How it is treated

Obviously, the recommended therapy will vary depending on the severity of the pathology.

Generally, vertebral stenosis can initially be treated pharmacologically with painkillers and anti-inflammatories, corticosteroid injections, rest and physiotherapy.

Only in the most severe cases will surgery be necessary, the aim of which is to decompress the canal, eliminating the narrowing, through the removal of portions of vertebrae or protruded discs, to restore physiological space to the spinal cord and nerves.

The operation ends with the stabilisation of the spinal cord through the placement of metal plates, screws or grafts.

Sometimes an interspinous spacer is also used, i.e. a fixed implant that maintains the correct space between the vertebrae.

Generally, conservative treatment is recommended when the symptoms of stenosis do not impair the patient’s quality of life and when the only detectable cause is ageing.

Conversely, surgery is recommended when there is a cause that may have serious consequences, such as a spinal tumour, when there is no perceivable margin for improvement with conservative treatment, when the patient’s quality of life is significantly impaired by the stenosis, and when the condition causes loss of sphincter control.

Surgery is not, however, the first choice because it presents rather high risks.

The physician must therefore take stock of the condition of the stenosis and any contraindications related to the operation in order to make the correct therapeutic choice.

Can lumbar stenosis be prevented?

Primary lumbar stenosis is a condition for which prevention is impossible.

In fact, in this case it is a congenital malformation of the spine that is impossible to prevent.

Secondary lumbar stenosis, on the other hand, is a different matter.

It can be prevented by reducing risk factors and keeping the spine healthy.

It is essential to maintain correct posture, whether sitting or standing, lift heavy loads using the right technique, and also to avoid the onset of herniated discs.

It is important not to smoke and to follow a balanced diet to avoid severe overweight and obesity, proven risk factors for the development of lumbar stenosis.

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