Degenerative lumbar spinal stenosis, is a leading cause of pain, disability and loss of independence in older adults. Lumbar spinal stenosis refers to a focal narrowing of the central canal and / or lateral foramina of the spine usually identified by imaging. It is interesting to note narrowing of the spinal canals alone with clinical information is not meaningful as 30% of patients over 55 years have narrowing (stenosis) but no symptoms.
Neurogenic claudication is the term used to describe the clinical syndrome caused by lumbar spinal stenosis. It is characterized by buttock, leg pain, heaviness, numbness, tingling or weakness brought on by walking and standing and relieved by sitting and bending forward.
There are many causes of narrowing of the spinal canals and these include; congenital variations, spondylolisthesis, some bone diseases and a previous spinal surgery. However, the most common cause is degenerative arthritis.
Degenerative or osteoarthritis is a wear and tear type of arthritis that we all get to some degree when we age. This kind of arthritis results in a thinning and bulging of the intervertebral discs and a thickening of the facet joints and internal spinal ligaments.
Degenerative spinal changes lead to a decrease in the area of the spinal canals and potential compression to the spinal nerves that travel to the lower extremities. The narrowed spinal canals also restrict blow flow to the spinal nerves with needs oxygen to function. This leads to neuro-ischemia and hypoxia to the nerves which results in leg pain and impacts the ability to walk.
Interestingly, patients who have difficulty walking due to lumbar spinal stenosis have greater limitations than those patients with hip or knee arthritis and even congestive heart failure or chronic obstructive lung disease. This leads to a sedentary lifestyle and a progressive decline in health status. As such lumbar spinal stenosis is chronic disease that can deteriorate with age. Given the aging population this condition is now associated with a large increase in health care resources.
What does a patient history with lumbar spinal stenosis look like?
Patients will typically describe leg symptoms as numbness, tingling, pins and needles, weakness or heaviness in the buttock, back of the thigh and lower leg that can impact their ability to walk. Back pain is not always present.
Using a shopping trolley or walker relieves symptoms, and some patients report a difficulty in balance which is due to the nerve compression in the lower legs.
What are the treatment options?
Degenerative lumbar spinal stenosis is the most common reason of spinal surgery in individuals over 65 years, however overall this is a small number of individuals. Patients who have leg dominant rather than back dominant symptoms tend to do better after surgery, many patients note the benefits of surgery tend to diminish over time.
The vast majority of patients receive non- surgical care including: physiotherapy, chiropractic, acupuncture, massage, medications and epidural injections. Anti-inflammatory medication and injections tend to be less effective as the symptoms are not due to inflammation.
The ability to reduce symptoms of degenerative spinal stenosis by changing spinal posture / structural alignment and /or increasing blood flow to the spinal nerve provides potential mechanisms for interventions to improve symptoms and walking ability. Dr Carlo Ammendolia and his team from the Mount Sinai Hospital have designed and implemented a six-week self-management program training program, a Boot Camp – which like any boot camp is very physical and tough, however, the goal is to provide patients with the knowledge, skills self-confidence and physical capacity to manage their symptoms and maximize their function on their own. Ailsa is trained in this program. The program is delivered one on one over six weeks and during this period a step by step home exercise program is designed and tailored to the individual with the goal of being maintained for life. This change of lifestyle approach has been studied by the University of Toronto in a clinical trial which demonstrated excellent short and long term results. Remember “Motion is lotion”.
For more information go to www.spinemobility.com