By Amanda N. Sacino, MD-PhD . Neurosurgeon and Managing Partner
Key Takeaways:
• Lumbar spinal stenosis is a condition characterized by the narrowing of the spinal canal in the lower back, leading to nerve compression.
• The prevalence of moderate and severe acquired lumbar stenosis increases with age to 47.2% and 19.4%, respectively, in the 60–69 year-old age group.
• Common symptoms include back pain, leg pain, and numbness, which usually worsen while standing or walking.
• Diagnosis is usually confirmed through an MRI scan after an initial physical examination.
• Treatment options vary from conservative measures like medication and physical therapy to surgical interventions like laminectomy.
• Early diagnosis and treatment can significantly improve quality of life and may prevent medical and neurological complications.
What is Lumbar Spinal Stenosis?
Lumbar spinal stenosis is a degenerative condition affecting the lower back. It involves the narrowing of the spinal canal, which houses the spinal cord and nerve roots, leading to compression and irritation of these neural elements. This condition most commonly occurs in people over the age of 50 due to age-related changes, although younger individuals can also be affected, often due to congenital anomalies or injury. The prevalence of moderate and severe acquired lumbar stenosis increases with age to 47.2% and 19.4%, respectively, in the 60–69 year-old age group.1 It is important to diagnose and treat lumbar spinal stenosis promptly to prevent worsening of symptoms and the development of neurological complications.
Common Symptoms: The Troubling Signs
The symptoms of lumbar spinal stenosis vary widely but generally revolve around the themes of pain, discomfort, and functional limitation. The most common symptoms include lower back pain, leg pain, numbness, and tingling. The condition may also lead to sciatica—a painful condition caused by irritation of the sciatic nerves, which runs from the lower back down to the legs. One of the hallmark features of lumbar spinal stenosis is “neurogenic claudication,” which manifests as pain or cramping in the legs that worsens with prolonged standing or walking and is alleviated by sitting down or leaning forward.
How Symptomatic Spinal Stenosis can Quickly Worsen Overall Health
Over the past decade, several landmark studies have shown that daily walking step count is a critical determinant of overall health and mortality. In 2020, a study published in JAMA showed that increases in daily step count from 4000 steps to 8000 steps daily cut mortality rates by 50%!2 Another follow-up study in JAMA in 2022 showed similar results, with lower risk of both cardiovascular and cancer mortality in persons with higher daily step counts. The importance of daily walking with high step counts, ideally 8000-10000 steps daily cannot be overstated. Spinal stenosis unfortunately is most often symptomatic when patients are upright and walking, and many patients self-regulate their pain symptoms by doing less of the activity that causes the pain. In this case, that translates into spinal stenosis patients walking fewer steps daily, thus worsening their overall health.
Diagnosis: Confirming the Condition
Diagnosis of lumbar spinal stenosis typically starts with a comprehensive medical history and physical examination. Your healthcare provider will assess your symptoms and may perform specific maneuvers to replicate the pain or discomfort you are experiencing. An MRI of the lumbar spine without contrast is generally ordered to confirm the diagnosis and assess the extent of the stenosis. These scans provide detailed images of the spinal canal and surrounding structures, allowing for precise evaluation and planning for potential surgical interventions.
Treatment Options: From Conservative to Surgical
Treatment for lumbar spinal stenosis is often stratified into conservative and surgical options. Conservative measures include medication for pain relief, physical therapy, and lifestyle modifications like weight loss and ergonomic adjustments. Corticosteroid injections may also be used to alleviate inflammation and pain temporarily. These measures are often effective in the early stages or for mild cases of stenosis.
Surgical treatment becomes an option when conservative measures fail to provide relief, or when the stenosis leads to severe or worsening neurological symptoms and decreases in quality of life. The most common surgical intervention is lumbar laminectomy. Laminectomy involves removing a small portion of the vertebral bone to decompress the spinal canal and nerves through a small incision in the midline back. Patients are often able to go home the same day of the surgery or by the next day. Surgical intervention aims to relieve symptoms and improve the quality of life.
Conclusion: The Path to Relief
Lumbar spinal stenosis can severely impact your quality of life, but understanding the condition and seeking prompt medical attention can make a significant difference. Conservative treatment methods are effective for many patients, but neurosurgical intervention may be necessary for severe or worsening cases. Consult your neurosurgeon for a comprehensive diagnosis and treatment plan tailored to your needs. Early diagnosis and treatment are key to preventing complications, maintaining high daily walking step counts, and improving your quality of life.
Apex Brain & Spine
Neurological Specialists
239-422-APEX (2739)
3530 Kraft Road, Suite 203 • Naples, FL 34105
www.apexbrainandspine.com
References
1. Kalichman L, Cole R, Kim DH, et al. Spinal stenosis prevalence and
association with symptoms: the Framingham Study. Spine J.
2009;9(7):545-550.
2. Saint-Maurice PF, Troiano RP, Bassett DR, et al. Association of daily
step count and step intensity with mortality among us adults.
JAMA. 2020;323(12):1151-1160.
3. Del Pozo Cruz B, Ahmadi MN, Lee IM, Stamatakis E. Prospective
associations of daily step counts and intensity with cancer and
cardiovascular disease incidence and mortality and all-cause
mortality. JAMA Intern Med. 2022;182(11):1139-1148.
About Amanda Sacino, MD, PhD
Dr. Sacino was born and raised on the east coast of Florida. After securing her undergraduate degree at Boston Unversity, she returned to her home state and attended the University of Florida, where she obtained her medical and post-doctorate degrees.
Her PhD work focused on proteinopathies, mainly Parkinsonism. But her mentors recognized her surgical precision skills, and so Dr. Sacino pursued extensive training in cranial, spine, and peripheral nerve surgery at Johns Hopkins Hospital. From there, she completed two spine fellowships at Johns Hopkins Hospital and the Swedish Neuroscience Institute. Her surgical spine training includes experience with degenerative diseases, congenital diseases, deformity, oncology, and trauma.
Dr. Sacino trained under Dr. Nicholas Theodore, the inventor of the Globus ExcelsiusGPS robot. She was present during the first robotic surgery at Johns Hopkins and trained extensively for five years with the robot during both spine and cranial cases.
Dr. Sacino’s high standards and pursuit of quality has led her to become well-respected by her mentors and peers. Her goal is to provide patients with case-specific solutions so they have all the information and options they need to make informed decisions.