Stenosis in general occurs when the spinal canal (which houses the spinal cord and its nerves) narrows, giving the spinal cord and nerves less room to move. This pressure on the spinal cord and nearby nerves can cause pain, numbness, weakness, bowel/bladder changes, and can even make standing or walking painful. Lumbar spinal stenosis is a narrowing of the spinal canal in your lower back.
In this Q&A, Alexander M. Crawford, MD, MPH , a fellowship trained spine surgeon and Assistant Professor, Orthopedics, Icahn School of Medicine at Mount Sinai, discusses the causes and treatments for lumbar spinal stenosis, how to relieve pain, restore your mobility and improve your quality of life.
Alexander M. Crawford, MD, MPH
“If you are experiencing lower back pain, sciatica, difficulty walking, or weakness in the legs, it’s time to see a specialist who can evaluate your condition, make a diagnosis, and develop the best treatment options to alleviate pain and improve your quality of life,” says Dr. Crawford. He treats the full spectrum of spinal disorders, including degenerative conditions such as arthritis and disc herniations, scoliosis, trauma, tumors, and complex revision surgeries. He offers both traditional open and advanced minimally invasive surgical approaches.
What causes lumbar spinal stenosis?
The spine is divided into three sections: the cervical spine (your neck), the thoracic spine (your mid back), and the lumbar spine (your low back). Your lumbar vertebrae stabilize your spine, supports most of your body weight, and helps maintain balance. With intricately affiliated nerves, muscles, and ligaments, this area of your spine controls your ability to walk, run, sit, lift, go to the bathroom, and move in all directions. Causes of spinal stenosis include:
- Arthritis and bone spurs
- Bulging or herniated discs
- Unstable segments of your spine, otherwise known as “slipped” discs
- Traumas, fractures, and tumors
How does lumbar spinal stenosis relate to aging?
Most commonly, spinal stenosis results from a degenerative aging process. As we age, our spinal ligaments may thicken and calcify, or our bones and joints (including those in your spine) may swell and develop bone spurs. Two forms of arthritis (osteoarthritis and rheumatoid arthritis) can also wear away the surface cartilage and cause an overgrowth of the bone that narrows the spinal canal. For most people, symptoms develop over time and can include one or more of the following:
- Back pain
- Numbness and cramping in the feet or legs
- Difficulty walking more than a few blocks
- A burning pain from the buttock down the leg that is often referred to as sciatica
How is lumbar spinal stenosis diagnosed?
To diagnose lumbar spinal stenosis, we start by taking your medical history and conducting a physical exam to assess your pain and symptoms. We also use an imaging test, such as an X-ray, magnetic resonance imaging (MRI) scan, or computerized tomography (CT) scan.
What are the nonsurgical treatment options for lumbar spinal stenosis?
To address early symptoms of lumbar stenosis, doctors prescribe nonsurgical treatments including:
- Physical therapy to strengthen the back, stomach, and leg muscles
- Application of ice and/or heat to affected areas
- Anti-inflammatory drugs
These treatments help to reduce inflammation, can relieve some pressure on the nerves, and can offer pain relief.
Another nonsurgical option is a series of spinal injections. Several types of injections may be used, varying by the medication delivered and the specific area targeted. Most often, patients receive a steroid injection—a strong anti‑inflammatory medication—directly into the irritated area to help reduce inflammation and ease pressure.
What are the surgical options for lumbar spinal stenosis?
We generally consider surgery only if these other methods are not effective at relieving pain or if you have severe weakness. When indicated, there are various types of lumbar surgery that are customized to different spinal disorders. These include:
- Microdiscectomy
- Laminectomy
- Fusion treatments using the most advanced techniques, including minimally invasive spine surgery, robotics, and microsurgery.
Microdiscectomy: This is one of the most performed spinal decompression procedures. The spinal surgeon may remove some or all the damaged disc, depending on the patient’s needs. We typically perform this surgery when spinal stenosis is caused by one bulging disc. Symptoms of a bulging disc include:
- Significant back pain
- Weakness or numbness in the leg or foot
- More pain in the leg or foot than in the back (i.e., sciatica)
Most patients experience considerable relief shortly after surgery. Patients typically return to work within two to six weeks of the procedure.
Laminectomy: This is another form of spinal decompression surgery for lumbar spinal stenosis. During this procedure, the surgeon removes all or part of the lamina, the portion of bone that forms the roof of the spinal canal. By relieving pressure, the spinal nerves have more space to heal. A laminectomy can relieve pain or other symptoms caused by conditions that affect your nerves and spinal column. In certain circumstances, there is even an option for a minimally invasive form of laminectomy to reduce your recovery time and help you feel better sooner.