Lumbar stenosis, along with herniated discs, is one of the pathologies that most frequently affects the lumbar area, i.e. the end of the back

A condition that, in addition to causing pain, can sometimes degenerate, leading to significant disability and even requiring surgery.

What is lumbar stenosis?

Lumbar-Sacral Stenosis or Lumbar Spinal Stenosis (LSS), from the ancient Greek ‘stenosis’ (‘narrow’), refers to one or more narrowings of the space that runs through the vertebral column in the middle and/or the lateral intervertebral foramen (i.e. the exit points of individual nerves from the column), at the level of the lumbosacral area.

The vertebral column is a bony envelope, traditionally divided into:

• cervical tract (the upper part)
• dorsal tract (the middle part);
• lumbar tract (the lower part).

In the middle it has a cavity (spinal canal or vertebral canal) that contains and protects the spinal cord and all the roots, i.e. the neurological structures that enable the functioning of:

• upper limbs;
• lower limbs;
• sphincters.

Symptoms and risks of LSS

The first symptom of Lumbar Stenosis is almost always lumbago, i.e. pain in the lumbar region, especially when standing or walking.

As the disease progresses, then, 80% of sufferers begin to experience additional symptoms affecting the lower limbs and manifesting after a short walk or even a few steps.

These symptoms require the cessation of movement and are a consequence of insufficient vascular supply to the nerve roots (claudicatio neurogenica intermittens).

These are often

• radicular pain, i.e. affecting one or both lower limbs,
• sensation of weakness;
• sensitivity disorders such as tingling, burning or foreign body sensation.

As the disease progresses, compressive/vascular suffering of the nerve structures and gait-related symptoms may also become permanent; in some cases, even partially reversible even after surgical treatment.

Causes of lumbar stenosis

The underlying causes of the pathology are diverse, but can be traced mainly to

• degenerative processes: this is the vast majority of cases, mainly related to ageing;
• traumas and injuries;
• congenital malformations (very rare);
• other pathologies (tumours, etc.).

How the diagnosis is made

The diagnosis of lumbar stenosis is first of all clinical, combining, during the neurosurgical examination, objective test and symptoms reported by the patient.

It must then be confirmed by in-depth investigations in the first instance neuroradiological such as:

• Magnetic resonance imaging, which makes it possible to assess
• degree of compression of the neurological structures
• presence of single or multiple stenoses;
• possible vertebral instability, a condition occasionally associated with stenosis and characterised by excessive movement of the vertebrae between them;
• Electromyography, which makes it possible to examine the degree and characteristics of nerve suffering due to stenosis.

Lumbar CT scans and X-rays with dynamic projections may also be useful in certain specific situations.

How lumbosacral stenosis is treated

Treatment of LSS can be

• conservative: if the symptoms are limited to low back pain and the neurological involvement of the lower limbs is of limited duration and extent;
• surgical: if the symptoms have been present for some time, with irradiation to the lower limbs and associated, in the most severe phase, with neurogenic claudication or sphincter involvement.

Conservative therapy

Conservative therapy is essentially based on

• drugs (cortisone and NSAIDs);
• infiltrations with oxygen-ozone (oxygen-ozone therapy), which exploit the natural anti-inflammatory and pain-relieving properties of ozone, to provide neurological and muscular benefits;
• physiotherapy, to strengthen muscles.

Conservative treatment, if carried out in the early stages of symptomatology, guarantees a marked clinical improvement that lasts over time and preservation of neurological functions.

Which exercises can help against lumbar stenosis

As far as the conservative phase is concerned, depending on the case, the patient may find benefit in practising moderate sporting activity with exercises that strengthen the back muscles, such as, for example, sports such as yoga and Pilates.

The surgical procedure

There are various surgical procedures for the treatment of lumbar stenosis, aimed at decompressing the affected nerve structures through the total or partial removal of certain bony and ligamentous portions of the spine (lamina, osteophytes, yellow ligament, etc.) or by spacing out the vertebrae.

All this is done by means of micro-surgical operations that, as far as single stenosis is concerned, very often require a single incision of about 2 cm in length.

Laminectomy

Among these operations, the gold standard for the treatment of LSS is the laminectomy, which involves the removal of one of the posterior bony components of the vertebra: the vertebral lamina.

The operation lasts between 30 and 60 minutes and can be performed under

• general anaesthesia, as is the case in most operations;
• simple sedation, which is only possible in certain specialised centres.

Vertebral fusion

Since, in any case, the removal of part of the bony structure of the vertebral column can lead to instability, a vertebral fusion may also be required in very selected cases.

This involves, as the expression itself indicates, the fusion of 2 or more vertebrae that are stabilised by means of metal plates, screws and synthesis means.

Lumbar Stenosis, the post-operative

A few hours after surgery, the patient is already able to move independently and, after a short overnight observation, can generally be discharged.

Support corsets and braces are not necessary, as is often believed, but a rest period of at least 10 days is recommended, during which, in any case, one is usually able to use a car for short distances, take moderate walks, and work a few hours at a desk.

With physiotherapeutic support, one will then gradually resume one’s usual daily activities.

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Source

GSD