Lumbar Spinal Stenosis

Lumbar spinal stenosis occurs when the spinal canal in the lower back narrows, putting pressure on the distal spinal cord and nerves.
This narrowing most often develops gradually with age and can lead to back pain, leg pain, cramping, numbness, or weakness, especially when standing or walking.

As the condition progresses, it can make everyday activities like walking, standing, or climbing stairs increasingly difficult.
With the right diagnosis and treatment, symptoms can be managed effectively, and patients often regain mobility and quality of life.

Lumbar spinal stenosis is most commonly caused by degenerative changes in the spine, but other factors may play a role.

• Bone spurs (arthritis): Overgrowth of bone narrows the spinal canal and compresses nerves.
• Herniated discs: Bulging or ruptured discs can crowd the canal and irritate nerves.
• Thickened ligaments: Ligaments around the spine may stiffen and enlarge, further reducing space.
• Degenerative disc disease: Loss of disc height brings vertebrae closer together, contributing to narrowing.
• Spondylolisthesis: A vertebra slips out of place, pinching the nerves below it.
• Congenital narrowing: Some people are born with naturally narrow spinal canals.
• Trauma or injury: Fractures or dislocations can rapidly create dangerous narrowing.
   

Symptoms of lumbar spinal stenosis often develop gradually over time and may worsen with activity, especially when standing or walking.
Many patients find relief when sitting or leaning forward, which temporarily opens up space in the spinal canal.

• Lower back pain that may be dull, aching, or radiating.
• Leg pain or cramping (neurogenic claudication): worsens with walking or standing, improves with rest or leaning forward.
• Numbness or tingling in the buttocks, thighs, legs, or feet.
• Weakness in the legs or feet, which may affect walking or balance.
• Reduced walking endurance: needing to stop frequently to relieve symptoms.
• Severe or urgent symptoms: sudden loss of bladder or bowel control or rapidly worsening weakness requires immediate medical attention.

Accurate diagnosis is essential to determine the extent of narrowing and guide treatment planning. Dr. Fried uses a step-by-step approach to identify the cause of your symptoms.

• Medical history: discussion of symptom progression, activity level, and lifestyle factors.
• Physical and neurological exam: assessment of strength, reflexes, sensation, gait, and posture.
• Imaging studies:
  • MRI: gold standard for visualizing nerve compression and soft tissues.
  • X-rays: detect alignment issues, degenerative changes, or spondylolisthesis.
  • CT scans: provide detailed bone anatomy, especially for surgical planning 
• Diagnostic injections: may help confirm the source of pain and differentiate spinal stenosis from other conditions.
   

Treatment for lumbar spinal stenosis is highly individualized, depending on symptom severity, overall health, and lifestyle goals.
Dr. Fried prioritizes non-surgical care first, reserving surgery for cases of persistent pain, worsening function, or neurological decline.