Lumbar spinal stenosis (spinal cord compression)

Description The most common cau...

Description

The most common cause of lumbar spinal stenosis is degenerative arthritis. As one ages the bones, the discs between the bones of the spine and the ligaments that connect these bones can begin to wear out. This results in loss of cartilage, extra bone formation (osteophytes), and loss of height of the discs. These processes cause a reduction in the normal spaces for the nerves to travel resulting in compression of the nerves and the symptoms of pain, weakness and numbness. Other causes include bone diseases such as Paget's, tumors and injury.

Symptoms

Low back pain, weakness, numbness, loss of bowel or bladder control, and/or muscle cramping.

Tests

Common tests used for diagnosis and treatment

Workup:
A history and physical exam will be done. If there is severe narrowing the provider may find numbness, weakness, or problems with the reflexes. A CT scan can detect the narrowing and an MRI can reveal damage to the nerves from compression.

Tests:
CT Scan, Magnetic resonance imaging (MRI), X-ray

Specialists:
Neurosurgery, Pain Medicine, Spine Surgery, Physical Medicine and Rehabilitation (physiatry)

Treatment

The course of therapy depends on the severity of the narrowing and the symptoms. Medical treatment is usually tried first and consists of antidepressants (amitriptyline/Elavil), anti-seizure medications (gabapentin/Neurontin, pregabalin/Lyrica), non-steroidal anti-inflammatory medications (ibuprofen/Motrin, naproxen/Naprosyn) and opiates (hydrocodone/Vicodin, oxycodone/Percocet). Surgery may be indicated for patients that do not improve with the above treatments. Typically surgery consists of enlarging the narrowed areas and is called a laminectomy.