Lumbar Spinal Stenosis
What is Lumbar Spine Stenosis?
Lumbar Spinal stenosis is a common medical condition, affecting the lower (lumbar) region of the back. It is a condition that increases in prevalence in an aging population and is a frequent reason for spinal surgery for adults over 65.
Spinal stenosis is characterised as an abnormal narrowing of the spinal canal – which is where the spinal cord runs. This leads to the compression of neural (nerve) and vascular (blood) structures within the spinal canal. This compression results in a painful presentation that can greatly impact and limit a person’s participation in day to day activities.
It is important to highlight at this point, that although spinal stenosis can be a debilitating condition, it is not life threatening.
Patients with spinal stenosis often complain of pain and weakness in the lower back, buttocks, thighs and lower legs. Patients often describe their symptoms such as an ache in the back, cramping or heaviness in their lower extremities. Such discomfort is commonly aggravated by prolonged standing and with prolonged walking.
How does it occur?
Acquired lumbar stenosis occurs as a result of age associated degenerative and/or arthritic changes that affects the lumbar spine. This affects the vertebral bones, the spinal joints and the discs between each spinal segment. This phenomenon can be explained in four steps:
- The earliest changes occur in the discs in-between each spinal segment. These discs may dry out and begin to flatten which can lead to a bulging disc and/or collapse of the disc segment.
- The loss of structural integrity of the disc causes additional stress on the spinal joints and ligaments (which connect the spinal vertebrae together). One of the important ligaments affected is the ligamentum flavum, which has a role in preserving upright posture and returning the spinal column to its original position after flexion (bending) movements.
- As a result, the extra stress may promote bone growth (osteophyte formation) and thickening of the ligamentum flavum.
- The area within the spinal canal and as the spinal nerves exist the vertebral column becomes narrowed due to the combination of the disc bulging, bone formation and ligament thickening. These factors results in less space for the spinal nerves and blood vessels.
The spinal canal and space also narrows further when placed in extension, hence limiting standing, walking and similar activities.
Physiotherapy management and treatment:
Physiotherapy management to treat lumbar spine stenosis aims to maximise the vertebral canal space and minimise canal narrowing. This can be achieved by reversing or reducing tissue inflammation and oedema in the joint space, strengthening the abdominal muscles, avoiding aggravating movements and activities and commencing a flexion-biased exercise program. Physiotherapy intervention aims to reduce patient symptoms and improve physical activity and function.
Often in moderate to severe cases, surgery may be required. In this case, a procedure called a “decompressive laminectomy” may be utilised to reduce the pressure and narrowing on the nerve roots. Here at Total Physiocare, we have an excellent affiliation with leading spinal and orthopaedic surgeons. Your physiotherapist can assess the severity of your condition, determine the best method of treatment unique to yourself, organise pre and post operative care as required, and prescribe expert rehabilitation exercises.
Post by Christian Bonello. Copyright 2015.