Are you suffering from severe lower back pain? Do these pains get worse when walking? If so, you are probably suffering from spinal stenosis lumbar, a condition that corresponds to a narrowing of the lumbar canal engendering a compression of the spinal cord.
In this article, find all the answers to questions about lumbar spinal stenosis, its causes, its clinical presentation and its therapeutic management.
A brief overview of the anatomy of the lumbar canal
Located between the thoracic spine and the vertebrae sacrococcygeal, the Lumbar spine is made of the stacking of 5 lumbar vertebrae named L1 to L5.
Fullerenes lumbar vertebrae are mobile and interconnected by intervertebral discs, and articular facets in their posterior parts.
Each vertebrate has an arc at the back (posterior arch), which delimits with the arcs of the other vertebrae a longitudinal tunnel called " Spinal canal ". The designation " lumbar canal is attributed to the lumbar spine canal.
The lumbar canal houses within it the spinal cord, and has laterally holes (foramina) letting through nerve roots (lumbar and sacral) which unite between them to give rise to the nerves responsible for the innervation of the lower limbs.
What is lumbar spinal stenosis?
Lumbar spinal stenosis, also called narrow lumbar canal, is a syndrome (set of symptoms) corresponding to damage to the lumbar spine which is characterized by a reduction in the diameter of its lumbar canal.
Le narrowing of the lumbar canal may be secondary to direct or indirect compression of its contents (spinal cord and its spinal roots).
This compression most often results from a range of factors responsible for more or less serious neurological lesions. But, in some cases, the compression is due to a naturally narrow spinal canal (constitutional lumbar canal).
From an epidemiological point of view, this condition is found more in subjects over 50 years of age. This would be explained by the fact that thelumbar arthritis is the most common cause of spinal stenosis.
Causes of Lumbar Spinal Stenosis
Several causes can be at the origin of the occurrence of a narrowing of the lumbar canal. If we refer to the types of stenosis, there are two:
- Constitutional lumbar spinal stenosis
- Acquired spinal stenosis
Constitutional lumbar stenosis
Like the cervical canal, the lumbar canal can be naturally narrow in some individuals. It is a malformation congenital which occurs from birth.
For example, this case is exemplified by a form of dwarfism called " achondroplasia ».
Acquired lumbar stenosis
As mentioned, the most common cause of acquired spinal stenosis isOsteoarthritis.
It is the culmination of an aging process of the spine which is seen in particular in people predisposed to having an osteoarthritic spine.
Pathophysiologically, it is a spinal degeneration which is characterized by the formation of lesions in the form of bony growths called " osteophytes ". These are likely to reduce the diameter of the canal and thus cause spinal stenosis.
Other acquired conditions can also cause spinal stenosis, including:
In this case, the culprit behind the spinal stenosis is the intervertebral disc. This one finds itself partially or completely displaced out of its normal anatomical situation.
People with hernia-related spinal stenosis usually complain of low back pain and sciatica.
This condition is capable of reducing the caliber of the lumbar canal by sliding of a vertebra forward (spondylolisthesis) or backwards (retrolisthesis) relative to the underlying vertebra.
Trauma can induce lumbar stenosis by direct mechanism. It can be a fall from a height or a traffic accident which can lead to vertebral fractures ending in reaching the contents of the spinal canal.
- bone cancer
- Secondary bone location of a tumor
- Hypertrophy of yellow ligament
- Paget's disease
How to recognize lumbar spinal stenosis?
It is easy to conceive that a disease such as lumbar spinal stenosis is necessarily responsible for alarming symptoms, due to damage to the spinal cord. However, this is not always obvious.
It can happen that people have lumbar spinal stenosis without even showing any symptoms. Most often, these people discover their pathology fortuitously.
When symptomatic, the clinical picture of lumbar stenosis is made up of:
- Low back pain or lower back pain
These pains can have various causes, but they generally characterize damage to the intervertebral discs and joints of osteoarthritis. They are of variable intensity (mild, moderate or severe) and evolve gradually with aging.
Result from compression of the nerve roots emanating from either side of the spinal cord. They can manifest as sciatica, cruralgia or radiculalgia depending on the location of the compression.
Depending on the degree of compression and the stage of progression, other symptoms may suggest lumbar stenosis, such as:
- Fullerenes paresthesias ou dysesthesias
- Fullerenes sensory or motor deficits
- Le cauda equina syndrome
- La neurogenic claudication
The diagnostic process
The use ofmedical imaging is essential, in particular to be able to differentiate its various causes, but also to document an asymptomatic stenosis.
In practice, medical imaging should include:
- A standard x-ray of the lumbar spine
Thanks to the face and profile and dynamic images, the x-ray allows, on the one hand, to confirm the presence of the narrowing by highlighting an osteoarthritis or a possible spondylolisthesis. On the other hand, it makes it possible to make a possible differential diagnosis in the presence of radiculalgia.
- Magnetic resonance imaging (MRI) or sometimes CT scan
In concrete terms, these two complementary examinations are indicated for:
- Detect the origin of persistent pain that resists analgesic treatment
- Assess the integrity of the spinal cord and its nerve roots as well as the intervertebral discs, and complete with an assessment of the intact structures.
- Consider surgery (systematic in this case).
In general, the choice of treatment depends on the evolutionary stage of the disease as well as the importance of its clinical symptoms.
Thus, at the beginning the doctor opts for non-invasive methods (drugs, natural treatments, etc.), and if these prove to be insufficient or ineffective, he will proceed to invasive methods such as surgery.
It is obvious that this type of treatment does not allow a permanent cure of lumbar stenosis, but most medical approaches have proven their effectiveness, in particular to relieve pain and improve the quality of life of patients.
This therapeutic component may include, among other things:
Usually, doctors recommend analgesics such as paracetamol, aspirin, NSAIDs, corticosteroids, muscle relaxants, etc.
Wearing a corset
This treatment is mainly indicated in stenosis of traumatic origin or related to spondylolisthesis. It is also recommended for people practicing activities involving significant physical effort.
In addition to drug treatment, physiotherapy (physiotherapy) gives very good results in the management of lumbar spinal stenosis.
It offers a variety of exercises aimed at reducing the intensity of pain and strengthening the muscles of the back.
As you will have understood, only surgery can definitively correct the problem of lumbar stenosis. However, it is only indicated in case of non-response to conservative treatment or immediately in case of emergency.
In practice, the surgical act consists of freeing the spinal cord by carrying out specific and sometimes delicate surgical techniques. By way of illustration, we can cite:
- Laminectomy or surgical release of the bone plates compressing the marrow.
- THElumbar arthrodesis posterior: which aims to stiffen the spine by connecting the injured vertebrae by means of screws and rods whose size depends on the radiological assessment.
A lumbar corset is often prescribed by the surgeon for a period of 3 months, to accelerate healing and prevent postoperative complications.