Lumbar Stenosis

The lumbar spine is formed by five lumbar vertebrae. The anterior part of the vertebrae or vertebral body is joined to each of the following ones by the intercalation of a fibrous structure called the intervertebral disc. The posterior part of the vertebrae forms a bony arch. The sum of all the superimposed arches constitutes the lumbar canal. This arrangement occurs analogously in the cervical spine and in the thoracic or dorsal spine.

Lumbar stenosis is a pathological condition due to narrowing of the lumbar canal, which can cause compression of the neural structures that are housed within it, either the dural sac with the spinal nerves, or the spinal nerves themselves that emerge through the foramina.

Compression of the nerves can cause low back, buttock and leg pain, lameness, pain and decreased sensation in the legs. A common symptom is improvement of pain when leaning forward, or aggravation of pain when the trunk is brought backward. Patients with lumbar stenosis usually walk somewhat bent over to avoid pain, have to stop frequently to sit down, and walk better uphill than downhill.

There are several forms of lumbar stenosis:

• The most common is degenerative lumbar stenosis, which occurs with advancing age. The exaggerated growth of the bones, ligaments and joint deformity can produce generalized stenosis (at various levels of the spine) or segmental stenosis (at a single vertebral level). The narrowing conditions a compromise of space for the nerves and a series of symptoms are produced, such as lumbar pain and in the buttocks, neurogenic claudication and pain radiating to the extremities. Neurogenic claudication is the inability to walk for a prolonged period of time due to pain, requiring sitting to relieve it.
• Congenital lumbar stenosis is less common, and can occur at any age, often between 30 and 40 years of age. It is due to a congenital narrowing of the lumbar canal. The causes are not very clear but it is possibly due to developmental disorders in early childhood.
• Stenosis secondary to a displacement of a vertebra forward or backward. It is called spondylolisthesis, and depending on the degree of displacement, there may be more or less narrowing in the affected vertebral segment.

Lumbar stenosis that produces symptoms requires treatment, which will initially be pharmacological and rehabilitative. If the problem cannot be alleviated, invasive techniques such as epidural corticosteroid infiltrations will be necessary. Surgery is the last resort, and there are different surgical techniques that can solve the narrowing. The surgeon is responsible for choosing the best technique for each individual case.

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