Lumbar Spinal Stenosis

by Dave O'Brien, PT, Diploma, MDT

Lumbar spinal stenosis is defined as a narrowing of the vertebral canal, lateral recess or interverterbral foramen. The vertebral canal is where the spinal cord and lower nerve roots are found as they descend down the spine. The lateral recess is the “exit ramp” the nerve takes as it leaves the canal and the foramen is the hole it emerges from. Narrowing of these spaces compresses the nerve.

  The prevalence of lumbar stenosis in the general population is unknown. It is a condition more commonly found in the middle aged and elderly population. Stenosis is associated with extensive degenerative changes in the spine at multiple levels.

  Symptoms of lumbar spinal stenosis can include discomfort in the thighs, calves and feet. Patients often describe the discomfort as weakness, heaviness and/or numbness. Low back pain may or may not be present. Symptoms generally worsen with walking or standing and are alleviated with sitting. Bending forward while walking (such as leaning forward on a shopping cart) may decrease symptoms when walking.

  A good history and exam are needed to differentiate stenosis from other pathologies involving the spine. If spinal stenosis is suspected, an imaging test will be needed to confirm the diagnosis. These tests may include MRI, CT Scan, and myelography.

  Since spinal stenosis is frequently a non-progressive disorder, conservative management such as physical therapy should be considered as an initial option fro treatment. Some elements of the condition may be reversible with the correct exercise prescription. Symptoms secondary to irreversible elements may be managed more effectively with exercise and education.

  Symptoms that are non-responsive to conservative management may require surgery. The purpose of surgery is to open up the spaces and decompress the nerves.