Multiple factors can contribute to lumbar spinal stenosis. Spinal stenosis can occur in the presence or absence of disc degeneration. Degeneration of the intervertebral discs often causes a herniation or slipped disc. This can narrow the spinal canal where the spinal nerves are located. As the disc degenerates, the disc height is reduced which narrows the foramen or tunnel where the spinal nerve exits the canal to travel to the lower extremity.
This also results in more force being placed on the facet joints surrounding the spinal canal at the affected level. This increased force leads to facet joint arthrosis, where the joint and its capsule increase in size and can lead to the formation of joint cysts. This is also referred to as degenerative arthritis. The surrounding ligament, or lgamentum flavum can also increase in size, also referred to as hypertrophy, as well to compensate for the increased force. These factors contribute to further spinal stenosis and can lead to spinal instability. Degenerative arthritis and ligamentum hypertrophy can occur independently of disc degeneration.
Symptoms of spinal stenosis can include lumbar radiculopathy or sciatica, pain, weakness, numbness, tingling, difficulty walking, inability to stand up straight with relief of symptoms when leaning over or sitting. The L4-5 spinal discs are most frequently affected by spinal stenosis, followed by L3-4, L5-S1, and L1-2.
Surgical intervention is recommended in symptomatic patients where radiographs confirm the presence of spinal stenosis. Conservative treatment options are still an important adjunct to surgical intervention. However, in mild cases conservative treatment options may be attempted with good results.
Dr. Ram R. Vasudevan, MD, FAANS
Austin NeuroSpine PLLC
5300 Bee Cave Road, Building 1,
Suite 220 Austin, TX 78746
Phone: (512) 640-0010
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