Am Fam Physician. 2003;67(10):2199-2200
What is lumbar spinal canal stenosis?
Lumbar spinal canal stenosis is a narrowing in the space in the lower spine that carries nerves to your legs. This space is very small. It gets even smaller if the bone and tissue around it grow. It takes many years for this bone and tissue to grow.
Arthritis, falls, accidents, and wear and tear on the bones and joints in the spine also play a part in stenosis. As the lumbar spinal canal shrinks, the nerves that go through it are squeezed. This squeezing may cause back pain, leg pain, and leg weakness. Many adults have this kind of stenosis.
How does my doctor know I have stenosis?
Your doctor will ask you questions about your symptoms. People with stenosis usually have back pain most of the time. They also may have leg pain, numbness, or weakness. The leg pain and numbness usually start when you stand up and begin to walk or exercise. The leg pain has been described as a burning or prickly feeling that may start in the buttocks and spread down to the feet when you start walking.
Your legs also might feel cramped, tired, or weak. These are symptoms of a condition called neural claudication (say this: claw-dih-kay-shun) of the legs. If you have lumbar canal stenosis, the neural leg claudication starts when you stand up, gets worse when you walk, and gets better when you stop walking. Often, the leg pain gets better if you crouch or lie in a fetal position (on your sides with your knees tucked up to your chest). It is thought that these positions “open” the lumbar canal and take the pressure off the nerves that go to the legs.
Leg claudication starts slowly but gets worse after a while. The leg pain begins slowly and gets worse with activity.
Although your doctor can probably tell if you have claudication just by asking you certain questions, sometimes special tests and x-rays of the spine are needed.
Is this the same as a ruptured disc?
No. Lumbar canal stenosis is not the same as a ruptured disc. A ruptured (herniated) disc usually pinches one or two nerves at a time. The pain caused by a pinched nerve in the lumbar spine usually is easy to diagnose. This pain has a special name: sciatica. Sciatica (say this: sigh-attic-ah) usually causes back pain that shoots down one leg. This pain can happen any time, not just when you stand up or start walking.
What can I do for the pain and numbness?
Once you know you have lumbar canal stenosis or claudication, you have several choices for treatment, depending on how bad your symptoms are. If your pain is mild and you have not had it long, you can try an exercise program or a physical therapy program to strengthen your back muscles and improve your posture. Your doctor also may prescribe medicine for inflammation (soreness and swelling) in your spine.
If you have severe back pain and claudication, you may need to see a spine surgeon. This doctor may recommend surgery to take the pressure off the nerves in your lower spine. The surgery is called a laminectomy (say: lam-in-ek-toe-me) because parts of your spine called the lamina are taken out to make room for the nerves in the spinal canal. This surgery works well for many people.