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The term “stenosis” is used to describe something that has become narrowed. Lumbar spinal stenosis (LSS) is becoming more common. It involves narrowing of the spinal canal, which extends through the spinal vertebrae, in the lower back. It may put pressure on the nerve roots that branch out from the spinal cord resulting in pain, tingling, numbness, muscle fatigue, and if severe, muscle weakness in the legs. It results from degenerative changes in the spine associated with aging. These changes include osteophyte (bone spur) formation, thickening of spinal ligaments, and degeneration of the discs between the vertebrae. This can cause loss of disc height, or narrowing of the space between the vertebrae, and disc bulging. Other spinal conditions can worsen LSS, for example slippage of one vertebra over another (spondylolisthesis) and degenerative curving of the spine (scoliosis).

LSS is a disease of aging. It is a common condition, affecting about 20% of the population aged 60 and over. Thankfully, about 80% of that group are unaware they have the condition as they have no symptoms, and, of course, therefore require no treatment. Most people with LSS have never had significant low back pain. The symptoms of the condition begin very slowly. Commonly, the first symptoms are pain and achiness extending from the lower back to the buttocks. Sometimes the pain is associated with numbness and tingling in the feet. The pain is typically worsened by standing and walking, and is relieved by sitting or leaning forward while standing. Over time symptoms usually worsen. The back and buttock pain often extends to the hip girdle muscles, including the thighs (hamstrings and quads). Rarely, it extends into the lower legs, but this is unusual. The patient eventually can only stand or walk short distances without needing to sit or stop and lean forward. Over time, some patients experience severe limitations in activity.

The fact that the pain usually spares the lower legs helps differentiate LSS from another condition that causes leg pain, namely vascular claudication. In this condition, the arteries supplying blood to the legs become severely narrowed. When muscles are in use, they require oxygen, supplied by a good blood flow, to function properly. Lack of oxygen causes pain. In those with vascular claudication, walking causes leg pain, typically in the calves and feet, which causes the patient to have to stop and rest, which relieves the pain. These patients have weak or absent lower extremity pulses. In LSS, the leg pain is higher, usually in the thighs and buttocks, and leg pulses are not diminished. However, because both conditions cause leg pain with walking, those with LSS are often said to have neurogenic claudication.

LSS is difficult to treat. Once diagnosed by exam and MRI imaging (or CT if MRI cannot be used), treatment involves activity modification, pain relief with NSAIDs, and physical therapy. Spinal injections may provide limited relief for a few weeks but are not helpful long-term and run the risk of infection or bleeding. Surgery, usually a last resort, may be helpful in some cases. Anyone with LSS who develops loss of bowel or bladder function or progressive leg weakness should undergo an urgent surgical evaluation.

For more info see: www.niams.nih.gov/health-topics/spinal-stenosis

Please direct questions and comments to editor@rockawaytimes.com

 By Peter Galvin, MG

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