When the spinal canal in the lumbar region narrows, it is called lumbar spinal stenosis.
What does the spinal canal look like?
The spinal canal, also called the vertebral canal, is the space through which the spinal cord passes, from the first cervical vertebra (called C1) to the first lumbar vertebra (L1), together with the nerve roots, with which the canal ends (at the level of the sacral vertebrae).
The spinal cord is part of the central nervous system, along with the brain. The nerve roots, however, are part of the peripheral nervous system, which is affected by lumbar spinal stenosis.
Delimited above from the vertebral bodies and intervertebral discs, laterally from the vertebral foramina and later from the ligamentous bone arch, the lumbar spinal canal contains the roots of the sciatic and crural nerves, directed towards the lower limbs. If compressed, the nerve roots cause particularly bothersome symptoms.
Causes of lumbar spinal stenosis
This pathology originates mainly from a very natural condition: advancing age and the resulting arthritic changes, which cause thickening of the walls of the lumbar canal and a reduction in the available space. It is therefore no coincidence that lumbar canal stenosis occurs especially in individuals over 60-70 years of age. Other causes may include:
- lumbar disc herniations
- spinal tumors, whose masses can occupy the space intended for the spinal cord
- spinal trauma
- lumbar spondylolisthesis, which alters the positioning of the lumbar vertebrae
- Paget's disease, which causes bone regeneration to be too fast, resulting in deformity
There are also more particular cases, in which the person it is born already characterized by a narrower section of the spinal canal of the norm: the symptoms therefore tend to appear well before old age. Some risk factors must also be considered: according to studies, people who suffer from obesity or diabetes mellitus, As well as smoking, are more predisposed to developing the pathology.
Lumbar spinal stenosis: symptoms
As the nerve roots in the canal gradually deteriorate, symptoms gradually develop. Initial symptoms include:
- backache
- pain in the buttocks, which increases when walking or standing still
- nighttime leg cramps
As the months and sometimes years pass, the following also appear:
- claudication (reduction of driving range)
- numbness and pain in the legs, which often force the person to stop while walking
The patient experiences some relief by stopping or leaning forward: this is because this position allows the diameter of the spinal canal to increase by about 10%, thus also decreasing the compression. This is why many people suffering from lumbar stenosis can ride a bicycle for miles, but paradoxically can only walk 10-20 meters.
How is a diagnosis reached?
Despite the difficulties described, the patient often does not present any other particular signs during the objective examination. It is therefore essential for the diagnosis to resort to a magnetic resonance of the lumbar spine, which allows for the detection of the pathology and possible association with other pathologies. The following can also be performed:
- spine x-ray
- TAC, especially to analyze bone components
- electromyography, to measure nerve function
Lumbar spinal stenosis: treatment and surgery
To address lumbar spinal stenosis with the right therapy, it is always necessary to base the decision on the individual patient's situation. You can opt for a conservative therapy as well as for a surgeryThe first option is preferable if the symptoms are not disabling or if there are no serious pathologies among the causes. Conservative treatment includes: pharmacological treatments (with anti-inflammatory, analgesic and muscle relaxant drugs), physical rehabilitation (muscle-strengthening exercises, water-based physical activity, stretching and cycling, manual, postural, and instrumental therapies) and lifestyle modification (quit smoking, regular physical exercise, weight control).
If these therapies do not give the desired result, lumbar spinal stenosis can be treated with surgery, which provides forwidening of the spinal canal By removing the occluded segment. This can be performed using different methods, the appropriateness of which is carefully evaluated by the neurosurgeon:
- laminectomy (bilateral approach)
- hemilaminectomy (unilateral approach)
Thanks to minimally invasive techniques, it is possible to decompress the canal without subjecting the tissues to excessive trauma, thus significantly improving recovery times. Furthermore, in recent years a method of endoscopic decompression, further advantageous from this point of view, but not indicated for all types of stenosis.
Following the surgery, it is advisable to undertake a physiotherapy program (FKT), the practice in physiotherapy that includes motor rehabilitation activities.
