Lumbar canal stenosis is the gradual narrowing of the spinal canal caused by age-related changes of the discs and facet joints in the lower back. This degenerative process is called spondylosis (spinal arthritis). As the stenosis progresses, it can lead to compression of the nerve root  running through the spinal canal result in radiating leg pain, numbness or weakness, also known as radiculopathy or “sciatica”. In some cases, spondylosis can result in spinal instability, allowing one bone to slip forward on top of the one below, a condition called degenerative spondylolisthesis.

Symptoms

• Lower back pain with radiation into hips and buttocks
• Radiculopathy – radiating leg pain or tingling/ numbness caused by compression of the spinal nerves
• Difficulty in standing or walking for long distances.
• Bladder or bowel urgency/ incontinence

Natural History – What happens when the condition is not treated

• Not all patients with stenosis have symptoms
• Symptoms may be short-lived and infrequent
• Patients may develop more persistent and debilitating pain as the stenosis or instability progresses

Three Phases of Treatment:

• Phase I – Non-Invasive Treatments
• Phase II – Spinal Injections
• Phase III – Surgery
• Goals of Each Phase:
  • Relieve Pain
  • Improve Function

Treatment Options: Phase I – Non-Invasive Treatments

• Physical Therapy and Regular Home Exercise
• Core and Back Strengthening
• Flexibility and Stretching
• Oral Medications
• Steroids
• Non-Steroid Anti-Inflammatories (NSAIDs)
• Pain relievers
• Muscle Relaxants
• Ice and Heat

Treatment Options: Phase II – Epidural Steroid Injections

• Outpatient procedure
• Done with x-ray guidance
• May relieve symptoms, but will not repair the disc
• 1-3 injections may be needed

Treatment Options: Phase III – Surgery

Surgical Options for Lumbar Stenosis and Degenerative Spondylolisthesis

• Learn more about  Lumbar decompression 
• Learn more about Percutaneous endoscopic lumbar decompression (PSLD)
• Transforaminal endoscopic lateral recess decompression (TE-LRD)

Lumbar Fusion

• Learn about Interventional Pain management/blocks
• Learn more about Lumbar Decompression
• Learn more about Transforaminal Lumbar Interbody Fusion (TLIF)
• Learn more about Minimally-Invasive Lumbar Fusion (MIS TLIF)

When spinal instability (degenerative spondylolisthesis) is significant, fusion may be necessary to fully relieve symptoms by restoring the proper spinal alignment and preventing further slippage