LUMBAR SPINAL STENOSIS

Spinal stenosis is the name given to a condition where the nerve is encroached-upon, thus causing pain and a variety of other symptoms. It can occur in any area of the spine, however we will be discussing lumbar spinal stenosis (LSS). Spinal stenosis is a form of sciatica not commonly associated with the sciatic nerve syndrome. Although it involves the sciatic nerve roots, it is more like a vascular disorder because the symptoms result in intermittent claudication. Intermittent claudication is the pain and cramping that occurs in the calf of the leg on exercising as in walking for a very short distance, and can be very severe. It is caused by a deficient blood supply to the muscle. This pain will ease within 2 to 5 minutes when the individual stops and rests. Because the vascular symptoms so closely resemble the neurological symptoms of lumbar spinal stenosis (LSS), a differential diagnosis must be made to determine the cause.

Lumbar spinal stenosis (LSS) is usually a chronic condition that results over a period of years and may be due to congenital or degenerative defects. It is not generally due to an acute episode, unless a trauma triggers the chronic condition that is present. In most cases the onset will be due to degenerative changes in the spinal canal or a forward slippage of one vertebra on another (spondylolisthesis). Congenital lumbar spinal stenosis is due to an irregularity in the spinal canal from the time of birth. It can also be caused by a surgery that affects the spinal canal (iatrogenic). Can also be caused by bone disorders such as Paget's disease.

The symptoms of lumbar spinal stenosis (LSS) can affect either one or both legs depending on the level at which the nerve is impinged. Usually this occurs at the 4th and 5th lumbar vertebrae, and the 5th lumbar vertebra and the sacrum (the broad triangular bone). This impingement affects the buttock, back of the thigh and the calf muscle. If the impingement is above the 4th and 5 vertebrae, the pain will affect the front of the thigh. Walking can be affected due to the pain.

Lumbar spinal stenosis (LSS) usually affects those 55 and older, and generally will affect more women than men. Symptoms of lumbar spinal stenosis (LSS) can start within 24 hours after lifting heavy weights. Tumors and infections, although not as prevalent can be the cause of LSS. Diagnosis generally involves the elimination of other diseases and is made by various diagnostic means such as x-rays, CT scans, MRI's or myelography. These diagnostic procedures can rule out tumors, bulging or ruptured discs.

Another confusing symptom that occurs in lumbar spinal stenosis (LSS) is of neurogenic (nerve) origin and has to be differentiated from a vascular (circulatory) origin. The comparison of the symptoms will give the individual an insight into what the cause of their pain is due to, whether it is of vascular or neurogenic origin.

In lumbar spinal stenosis of neurogenic origin the individual will have back pain for many years, or has had a history of back pain of gradual onset. If the condition is of vascular origin, there will rarely be back pain. In the neurogenic patient there will be sharp-shooting leg pains, whereas the vascular patient will have severe cramping pains (intermittent claudication). Walking uphill will not usually precipitate pain in the neurogenic patient, while walking downhill may. In the vascular patient, walking uphill will generally cause pain, but downhill is better. Walking or standing for any length of time will cause the condition to be aggravated in the neurogenic patient, while in the vascular patient, walking may aggravate them, but standing does not. Pulses can be found in the legs of the neurogenic patient, but will be absent in the vascular patient.

The individual who has been plagued by any of the symptoms we have discussed, should of course seek professional advice. Lumbar spinal stenosis is identified at the early stages can probably be treated on a conservative basis with a good deal of success. The Chiropractor can offer the conservative care to alleviate the pain and possibly prevent the condition from advancing into a more chronic, degenerative state. In very severe conditions, there may have to be further collaboration with a medical doctor.

In severe cases surgical intervention may be necessary to remove any spurs or bony overgrowth into the spinal canal that is impacting the nerve or nerves. I cases, before radical surgery is even considered the patient may be given epidural injections to relieve the pain. However, it is up to the individual to know what exactly is going on so that they can make the necessary decisions that will best for their health and welfare.

Treating any condition by conservative means is of course the first choice. As previously mentioned lumbar spinal stenosis (LSS) can successfully be treated to make the patient lead a more pain-free and active lifestyle. Chiropractic care will start them on the right road. Conservative spinal manipulation will increase the spinal foramina to allow the nerve to exit without abnormal impingement. The use of electric muscle stimulation and ultrasound will offer relief from pain and muscle spasms. He/she may also recommend other measures, for the patient to follow.

The patient must also take their treatment a step further. Treatment at home is a most necessary adjunct to the doctor's treatment. Rest of course is important. Refraining from any activities that will aggravate the back in any way should be avoided. Lifting weights over 5 pounds and reaching objects from over the head should not be attempted. Any sports, such as golf or bowling, should be played cautiously if at all during the painful stage because of the necessary twisting of the back.

There are several modalities that can be used at home. Hot showers two times a day and let the water beat down on the low back. Rubbing in a good analgesic 3 to 4 times daily. Heat pads (preferably moist) used for 15 minutes at each session and used 3 or 4 times daily as needed. A mechanical massager used for 3 minutes can help relieve muscle spasms. NOTE: DO NOT use a massager on the legs if you have a vascular or circulatory problem.

Exercise will be extremely important to maintain flexibility, muscle tone, balance and strength. The flexion exercises will help to open the spinal foramina, taking pressure off the nerves. They will also strengthen the abdominal and back muscles that keep the spinal biomechanics in a more normal structural balance. This normalization of structural balance will be extremely important in preventing lumbar spinal stenosis from progressively becoming worse. So, again it is up to the individual to do what is necessary to help themselves if they are to live a happy, pain-free and active lifestyle.