What Is Lumbar Spinal Stenosis?

Lumbar spinal stenosis (LSS) is quite literally a "pain" - in the back, legs and rear. This degenerative spine condition occurs when nerves in the lower spine become pinched, typically caused by normal wear and tear of the spine.

While causes of pain exclusively affecting the back are quicker to recognize, it can be a bit more complicated when that same back issue is affecting other parts of your body. Lumbar spinal stenosis is a spine-related health condition resulting in other body parts being negatively involved.

What Is Spinal Stenosis?

Spinal stenosis is a condition where the spinal canal, the space within the spine that houses the spinal cord and nerve roots, becomes narrowed. Spinal stenosis is usually related to a loss of joint cartilage and bone, but it can also be triggered by arthritis or bone spurs, disc herniation, or other factors.. The narrowing of the spinal canal puts pressure on the spinal cord and the nerves that go out to the arms and legs, causing pain, tingling and numbness.

"The canal, which is the highway for the nerves to run down, can have any amount of stenosis," said Wajeeh Bakhsh, MD, a board-certified spine and orthopedic surgeon at Franciscan Health.  "If you kind of compare it to driving down an expressway, there could be one lane closed, two lanes closed or three lanes closed. That can definitely affect the degree of symptoms and kind of change what our treatment options are." 

What Causes Spinal Stenosis?

"The most common cause is degeneration over time," Dr. Bakhsh said. "Arthritis and wear and tear throughout the spine leads to the walls kind of closing in. You have what we call tissue hypertrophy. There's a ligament that helps support the spine and that gets thicker with age. And if that gets too thick, you can start crowding the nerves. The bone spurs from the vertebrae in the spine can start kind of creeping in from one side. All of that contributes to narrowing the canal in a degenerative picture."

A herniated disc from a spine or back injury can also cause spinal stenosis "What a disc herniation is, is disc material that's supposed to be within the spine, the bony spine, that can kind of squish out into the canal." Dr. Baksh said. "And then you have something taking up quite a bit of space in the canal. So similar to how we described it with the expressway, now you've got two, three lanes closed because of this disc herniation. So you've got a lot of traffic and that can contribute to spinal stenosis."

Who Is At Risk Of Spinal Stenosis?

Risk factors for spinal stenosis include:

Age

Spinal stenosis usually happens in people ages 50 or older. In younger people, congenital spinal stenosis can be caused by a genetic condition that interferes with bone and muscle growth throughout the body.

"As we age, our spinal canals get smaller, and people in that demographic end up with spinal stenosis and symptomatic spinal stenosis," said John Kihlken, MD, Franciscan Health Spine Center Medical Director.

Previous back or spinal injury

A previous back or spine injury, such as a twisting or lifting injury or an injury from a car accident, can result in a disc herniation.

Your weight

"The heavier you are, the more stress your back sees," Dr. Bakhsh said, "and that can lead to a little bit more rapid thickening of the ligaments and wear and tear throughout the spine. When you get really into clinical obesity, you can have a prominence of fat within the spinal canal, that can contribute to taking up space there."

Smoking

"As always smoking is a factor for just about everything that causes pain," Dr. Bakhsh said.

Can You Prevent Lumbar Spinal Stenosis?

Lumbar spinal stenosis isn't preventable, but keeping up with your spine health can help lower your chances of being diagnosed with spinal stenosis early in life.

Ways to keep your spine in good health include:

Manage your weight

Weight can add stress to the back and spine and eventually reveal additional symptoms related to lumber spinal stenosis.

Exercise

Regular exercise can improve the strength of your lower back muscles and lower the chance of your nerves being pinched in that area.

"It is important to stay active," Dr Bakhsh said. "We always say use it or lose it, and that really does play a role here. Don't let it slow you down too much.

"Stay active. Stay loose. Keep moving around. Even if it hurts a little bit, kind of, the the whole goal is to stay active and live the best life that you can. And when it gets to the point that you need help, we're always here."

Use good posture

Good posture isn't just something your grandma warned you about. Improving your posture while sleeping, sitting, standing, and performing physical activities is crucial to reducing the risk of lumbar spinal stenosis.

Stop smoking

In addition to causing multiple diseases, cigarette smoking causes inflammation and impairs immune function. This hampers your ability for your back to heal.

What Are Symptoms Of Lumbar Spinal Stenosis?

Lumbar spinal stenosis does not show any early symptoms.

In most cases, the signs of lumbar spinal stenosis begin to appear progressively. Since the condition can have a wide range of symptoms, it may be complicated to find its source without professional care.

Most cases of spinal stenosis affect the neck and the lower back. Even though spinal stenosis can appear anywhere throughout the spine, it usually develops around your set of lumbar vertebrae at the lower part of your back. Lumbar spinal stenosis happens when the spinal canal narrows around your lower back.

People with lumbar spinal stenosis might notice some back pain when walking for longer periods.

The telltale signs are aching pain in the legs, pain that can kind of travel down the backs of the thighs and go down into the legs or the feet," Dr Bakhsh said. "This pain is usually worse with standing or walking. Patients will notice they can't really stand or walk really far without having to either lean forward over something or take a seat and take a break for some relief." 

Other spinal stenosis symptoms include:

• Leg pain or cramping
• Leg numbness or tingling
• Bowel and bladder control failure
• Sciatica (burning sensation traveling from the butt to the legs)
• Fatigue
• Impotence

How Is Lumbar Spinal Stenosis Diagnosed?

If your doctor or healthcare professional thinks you may have lumbar spinal stenosis, they may take the following steps to diagnose the condition:

• A physical exam that may assist with identifying physical symptoms related to the condition, including points of pain or numbness.
• An X-ray to locate possible bone growths that cause the spinal canal to narrow.
• Other imaging tests, including a CT or MRI, may provide the professionals with a closer look at the area of concern. These imaging tests can be recommended alongside more specific exams, including bone scans, myelograms, and an EMG.

"When someone is telling me that they have these specific symptoms, I can suspect spinal stenosis and then to diagnose it we can look at the spine in a 3D way with an MRI," said Dr. Bakhsh.  "It's typically found in adults because the most common cause of it is degeneration and wear and tear over time."

How Do You Treat Lumbar Spinal Stenosis?

After being diagnosed with lumbar spinal stenosis, you may be recommended to a professional specializing in nerves, arthritis, or even physical therapy. While neurologists and rheumatologists will prioritize the treatments of your nerves and the source of the spinal stenosis, specifically osteoarthritis, a physical therapist will prioritize your overall ability to move. A physical therapist will guide you through exercises to improve the strength of your limbs, back, and stomach while providing equipment for comfort.

Other forms of treatment for lumbar spinal stenosis include:

• Prescription medicine
• Acupuncture
• Spinal stenosis surgeries such as a laminectomy, Vertiflex or spinal fusion surgery. "The end goal is to do what you need to do to get symptom relief and take the pressure off the nerves. And a quick chat with a surgeon will help you sort that out," Dr Bakhsh said.
• Steroid injections
• Chiropractic care

Home treatment options for spinal stenosis symptoms

At-home treatments to help manage some symptoms, such as pain and discomfort associated with spinal stenosis, may include:

• Massages
• Hot showers
• Ice packs
• Heated pillows
• Nonsteroidal anti-inflammatory medications (aspirin and ibuprofen)

Although nonsurgical spinal stenosis treatments can manage symptoms, restore function and relieve pain, they don't reverse narrowing in the spinal canal. 

"Even though spinal stenosis can slow you down, you can lead a healthy life," Dr. Bakhsh said.