Do you have a chronic back pain and numbness in legs?
But the lumbar disc is normal?
Many people suffer from chronic low back pain and numbness in the legs. And we often know that it is from herniated disc, but there are many times it is not a disc problem. So today, I like to discuss about ‘lumbar spinal stenosis’.
What is Spinal Stenosis?
The spinal canal is a pipe-like structure that runs like a tunnel in the spine. In other words, you can think of it as a tunnel formed by connecting the holes in the vertebrae that are connected up and down.
Spinal stenosis is a painful disease because the bones, joints, ligaments, etc. become enlarged or grow abnormally, narrowing the spinal canal and pressing the nerves, whereas lumbar disc herniation is a disease in which the disc material, such as jelly, comes out of the disc and presses the nerves.
What are the causes?
- Congenital: Congenitally, lumbar vertebras are made smaller than normal. Symptoms occur due to changes in bones and ligaments over 35 years of age, but sometimes even younger ages around 20 years old.
- Acquired (degenerative): As the most common cause, as we age, as degenerative arthritis develops, the joints and ligaments become enlarged, and bones grow excessively and press the nerve pathways.
What are the symptoms?
Spinal stenosis is a symptom of pain in the back and numbness in the legs, very similar to a herniated disc. However, unlike herniated discs, the pain is less when sitting, and when you walk a little, the leg hurts, and it shows a gait disorder characteristic of resting and walking again. Particularly when walking, the legs and buttocks are severely numb, pulling, and painful, and there are cases of limp walking, and some describe that the legs are not the same as mine and are cold. At this time, sitting for a while and then walking relieves the pain, but the distance you can walk becomes shorter and your daily activities are hindered, so you visit the doctor’s office. However, it is not easy to distinguish between disc herniation and spinal stenosis by symptoms alone.
Diagnosis / Test?
- Exam: The older symptoms gradually worsen. It is better feeling when sitting.
- X-ray: The bones around the lumbar vertebras may overgrow and the height of the intervertebral discs may decrease.
- Other tests: With tests such as myelography and MRI, you can confirm that the spinal canal where nerves pass through is narrowed.
- Conservative treatment: Physical therapy, posture correction, drug therapy (painkillers, anti-inflammatory drugs, muscle relaxants, etc.), steroid injections, etc.
- Surgical treatment: If conservative treatment fails, the pain is getting worse, legs numbness worsens, legs muscle weakens, and the gait disorder continues, surgery is necessary. It can be summarized as laminectomy and spinal fusion.
What are the prognosis and complication?
If spinal stenosis progresses, and the symptoms of spinal cord injury appear, minor weakness of the legs and difficulty urinating may occur. After surgery, pain, etc. may improve, but some symptoms such as numbness may remain.
How to prevent?
- Degenerative diseases are closely related to the usual lifestyle, so you should avoid carrying heavy things or straining the spine.
- When sitting or standing, the spine should be properly positioned.
- The maintaining a moderate weight may slow down the degeneration process of the spine.
- Quit smoking is known to be good for low back pain.
- Exercises such as strength training, stretching, and swimming are helpful.
* The difference between spinal canal stenosis and lumbar disc herniation are not always consistent, but in general, the following differences may exist:
Lumbar Spinal Stenosis
More common in old ages
Better when sitting
It appears slowly over a long period of time.
Better when bending over.
While lying down, you can lift your legs more than 60 degrees without pain.
Lumbar Disc Herniation
More common in young ages
Worse when sitting
It often appears acutely.
Worse when bending over.
When lying down and raising the leg more than 60 degrees, the pain in the lower back, buttocks, thighs, and legs as well as severe pulling may appear.
Yoon Park, MD
Edmonds Medical Clinic