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Lumbar Spinal Stenosis

Lumbar Spinal Stenosis

Lumbar spinal stenosis is a medical condition wherein the spinal canal gets narrower, which compresses the spinal cord and nerves situated inside. This is commonly due to natural degeneration as individuals age. Its symptoms include pain, numbness, and muscle weakness that intensify over time.

Medically reviewed by Dr Chua Soo Yong ,
Consultant Orthopaedic & Spine Surgeon
MBBS (S’pore), MRCS (Edinburgh), MMed (Ortho), FRCS (Ortho), FAMS (Ortho)

What is Lumbar Spinal Stenosis?

Lumbar spinal stenosis refers to the gradual narrowing of the spinal canal, which increases the pressure placed on the spinal cord and the nerve roots that extend through the lower back into the legs. It tends to occur in the lower back, and has associated symptoms of weakness, pain and numbness in the arms or legs, particularly when walking or standing. Sometimes, it can be asymptomatic.

This condition is chronic and develops slowly over a long period of time. It is caused by some factors, such as the natural ageing process that causes spinal discs to lose their elasticity and the growth of bone spurs. Consequently, this condition is more common among older adults between the ages of 50 and 60.

In serious cases, surgery may be necessary to create extra space for the spinal cord and nerve roots, thus reducing the pressure placed on them.

What Causes Lumbar Spinal Stenosis?

The causes of lumbar spinal stenosis can be categorised into two main groups: acquired and congenital.

Acquired Causes:

Acquired spinal stenosis are typically caused by an injury or spinal changes that occur due to ageing:

Excess Bone Growth
This can cause excess bone to grow into the spinal canal. Causes for excessive bone growth include certain bone diseases or the formation of bone spurs.
Herniated Discs
Known as a slipped disc, herniated disc or prolapsed disc, these discs act as shock absorbers in the spine and they tend to wear off with age. The herniated disc may compress a nerve, causing pain, numbness or weakness in the legs.
Spinal Tumours
Abnormal growths may form within the spinal cord or in the spaces between the spinal cord and vertebrae.
Spinal Injuries
Traumatic spinal injury can lead to the fracture or dislocation of bone and affect the spinal canal. Inflammation and swelling can also place additional pressure on the spinal cord and nerve roots.
Thickened Ligaments
The cords that hold the bones in the spine firmly together can become stiff and thickened over the years, potentially bulging into the spinal canal.

Congenital Causes:

Congenital causes are present at birth, which may include:

Spinal Dysraphism
This is an umbrella term for various conditions that affect the spine, spinal cord, and nerve roots during foetal development, including spina bifida, tethered cord, and neural tube defects.
Achondroplasia
This genetic disorder interferes with bone development, resulting in shorter, abnormally-shaped bones and shorter stature (dwarfism).
Congenital Short Pedicles
This condition happens when the bony sides of the spinal canal, known as vertebrae pedicles, are shorter in length, reducing the size of the spinal canal.
Multiple Hereditary Exostoses
Also known as diaphyseal aclasis, this condition occurs when small, noncancerous bone lesions (osteochondromas) appear in the vertebrae and impede the spinal canal.
Congenital Kyphosis
This condition occurs when the spine curves outward excessively, causing the upper back to appear rounded or deformed.

What are the Types of Spinal Stenosis?

Depending on the location of the stenosis and the nerves affected, there are two types:

Cervical Stenosis
Occurring in the neck area, symptoms include: numbness, weakness, pain and tingling sensations in the hand, arm, foot or leg; balance issues; neck pain; or even the sudden onset of bowel or bladder problems.
Lumbar Stenosis
Occurring in the lower back area, it is the most common form of spinal stenosis and symptoms include: numbness, weakness, pain and tingling sensations in the foot or leg (especially when walking or standing for extended periods of time); back pain.

What are the Risk Factors of Lumbar Spinal Stenosis?

Age: The condition is more prevalent in individuals who are over the age of 50.
Sex: Women have a higher risk of developing spinal stenosis than men.
Genetics: People with a family history of lumbar spinal stenosis are more susceptible to developing the condition.
Spinal Problems or Injuries: Previous injuries or deformities in the spine, such as scoliosis, can lead to instability and narrowing of the spinal canal.
Joint Diseases: Conditions like osteoarthritis or rheumatoid arthritis can cause inflammation and damage around the spinal column, leading to spinal stenosis.

If you notice any of the symptoms or risk factors mentioned, please seek medical attention.

Contact Dr Chua Soo Yong at 6262 0555 for an accurate diagnosis today.

How is Lumbar Spinal Stenosis Diagnosed?

When diagnosing lumbar spinal stenosis, a specialist in spine conditions will ask about the patient’s symptoms and back issues. They will also conduct a complete physical examination to identify signs of loss of sensation, limited range of motion, muscle weakness, or abnormal reflexes. The doctor may also perform several imaging tests in order to diagnose the condition accurately.

Treatments for Lumbar Spinal Stenosis in Singapore

Depending on the severity and type of spinal injury, a suitable treatment plan will be tailored to your specific condition. This may include:

Non-surgical Treatment for Lumbar Spinal Stenosis

Lifestyle Changes
Maintaining a healthy body weight, doing suitable exercises and staying active, using walking support, using heat packs or ice packs for pain and inflammation relief.
Physiotherapy
This will help to improve the strength, flexibility and stability of your spine. It also increases your sense of balance.
Medications
This is usually a variety of pain relief medication ranging from over-the-counter ones to prescription ones.
Steroid Injections
In cases of severe pain, certain medicines can be directly injected into the spine, such as epidural, corticosteroid/cortisone injections. These produce an anaesthetic and long-lasting effect.
Decompression
Suitable only in lumbar stenosis, fine instruments are used to remove a part of a thickened ligament in order to increase the space in the spinal canal and relieve pressure.

Surgery for Lumbar Spinal Stenosis

Should all the above fail to treat the spinal stenosis effectively, surgery will be recommended. Typically, surgery to treat spinal stenosis comes with the purpose of reducing the pressure exerted on the spinal cord and nerve roots.

Depending on the type of surgery, this can be achieved through minimally invasive methods as well. Some common surgical procedures for lumbar spinal stenosis include:

Laminectomy
Here, the surgeon removes a portion of the lamina, the bony arch of the vertebrae, and a thickened tissue to create more space within the spinal canal. Laminectomy can relieve the pressure on the spinal cord and nerves, reducing pain and improving mobility.
Spinal Fusion
This involves fusing two or more vertebrae together using bone grafts to form a single, firm bone structure. In some cases, spinal fusion may be recommended to relieve nerve compression and restore spinal stability.

What Can I Do to Prevent Lumbar Spinal Stenosis?

While it may not be possible to completely prevent lumbar spinal stenosis, there are things you can do to lower the risk, delay its onset, and improve general spine health. These include:

Maintain a Healthy Weight
Being overweight increases pressure or strain on the spine. By maintaining a healthy weight through a balanced diet and exercise program, an individual can reduce the risk of developing spinal conditions.
Stay Active
Regular physical activity helps strengthen the muscles and ligaments that support the spine and improves overall spine stability.
Practise Good Posture
Maintaining proper posture while sitting, standing, and lifting can minimise stress and compression on the spine. You should avoid slouching and use ergonomic chairs and supportive pillows for back support.
Quit Smoking
Smoking can impair blood flow, reduce oxygen and nutrient supply to the spinal tissues, and affect bone healing.

What are the Complications of Spinal Stenosis?

If left untreated, lumbar spinal stenosis can worsen and result in complications, such as:

Chronic Pain
Lumbar spinal stenosis often causes pain that can extend from a localised area of the body to other surrounding body parts, such as the legs, buttocks, and neck.
Weakness and Numbness
Nerve compression in the spine can result in muscle weakness and numbness in the legs, which makes one experience balance problems.
Loss of Bladder or Bowel Control
In some cases, the nerves connected to the bowel or bladder may weaken, leading to incontinence.
Reduced Mobility
This condition limits one’s ability to walk, move, and perform everyday activities.
Disability
In severe cases, lumbar spinal stenosis can progress to the point where one becomes disabled due to some degree of paralysis or severe weakness.

It is crucial to seek guidance from a medical professional or spine specialist to determine the most appropriate treatment for lumbar spinal stenosis. They will consider factors such as the severity of symptoms, the patient’s overall health, and personal preferences.

FREQUENTLY ASKED QUESTIONS

Find answers to commonly asked questions here

Lumbar spinal stenosis does not typically heal on its own. It is important to seek medical attention for an accurate diagnosis and treatment plan.

Walking can be beneficial as it is a form of low-impact exercise that can strengthen the muscles supporting the spine, improve flexibility, and promote blood flow to the affected area. However, you should still seek medical attention to combine it with professional treatment for optimal results.

OUR SPINE SURGEON

Dr Chua Soo Yong

Consultant Orthopaedic & Spine Surgeon

MBBS (S’pore), MRCS (Edinburgh), MMed (Ortho), FRCS (Ortho), FAMS (Ortho)

With over 10 years of specialist experience, Dr Chua Soo Yong is skilled in treating a wide range of complex back, neck, and spine conditions, including lumbar spinal stenosis. His special areas of interest include open and minimally invasive spinal surgery, decompression, and instrumented fusion and disc replacement surgery. In addition to his expertise in complex spinal surgery, Dr Chua has contributed to the field through his involvement in the research of spinal cord injury and regeneration.

Make an appointment with our specialist, Dr Chua Soo Yong, at 6262 0555 today.

We are well-equipped to diagnose and treat all back, spine, and neck injuries.

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