Lumbar spinal stenosis is a condition that usually affects patients over the age of 50 and results from the narrowing of the open space (spinal canal) in the lumbar spine. Normally, lumbar spinal nerves are encased in a fluid sac and are protected by the lumbar vertebrae (bones). In the degenerative process (‘wear and tear’) of the spine, this space narrows which results in pressure on the spinal nerves. This pressure on the spinal nerves is usually the cause of your symptoms.

Lumbar spinal stenosis is usually a result of many factors. During the degenerative process, discs lose height while ligaments and facet joints can increase in size all of which can bulge into the spinal canal and compress nerves. This process can be accompanied by a decrease in the normal alignment or stability of the vertebrae. This causes further strain on facet joints and the body attempts to reduce this instability by growing bone around the disc which forms an osteophyte (bony spurs).

Osteophytes, the bulging discs and enlarged facet joints all protrude into the spinal canal, causing it to become narrow which produces stenosis and increased pressure on the nerves.
Signs & symptoms What tests are needed? How is it diagnosed? When surgery will be considered Surgical treatment

Signs & symptoms

In cases of lumbar spinal stenosis, most symptoms usually resolve spontaneously over about six weeks. Symptoms of claudication are less likely to improve. Signs and symptoms that patients experience include:

  • Neurogenic claudication is a common symptom of lumbar spinal stenosis. It usually occurs when you walk, and usually presents with a combination of heavy or weak legs, numbness or a burning pain that can be felt down to your feet which is relieved while resting.

  • Sensation changes such as numbness or pins and needles (paraesthesia) in the bottom of the leg or foot.

  • Shooting pain that travels down the leg (radicular pain/sciatica). This is usually from compression of the spinal nerve that travels down to the leg.

  • Low back pain that can be quite generic in nature or focused at a particular spot. LBP can be accompanied with radicular pain/sciatica. In lumbar spinal stenosis, this pain is often worse when walking.

What tests are needed?

Magnetic Resonance Imaging (MRI) and/or Computed Tomography (CT) will be performed when planning surgery to help confirm diagnosis, understand the anatomy and show how much diameter of the canal is reduced. X-rays are performed to assess spinal alignment, if the discs have lost height, if there are osteophytes (bony spurs) and if there is lumbar spondylolisthesis (if your vertebrae has slipped onto the vertebra below it.)

How is it diagnosed?

Diagnosis is made from the findings of the clinical history, examination, your symptoms and relevant tests.

When surgery will be considered

  • Cauda equina syndrome. A large disc prolapse can stop the function in lumbar spinal nerves. This produces cauda equina syndrome which results in numbness around the bottom, loss of power in the lower legs and feet as well as loss of bowel and bladder control. This is a medical emergency and you need to see a spine surgeon immediately.

  • Worsening and progressive symptoms of neurogenic claudication.

  • Sensation changes such as numbness or pins and needles (paraesthesia) in the leg/s.

  • Significant radicular pain (or sciatica)- shooting pain that travels down the leg and/or buttock pain.

  • Surgery will be considered as the last resort when you have ongoing symptoms despite non-surgical treatment.

Surgical treatment

The aims of surgery for lumbar spinal stenosis are to relieve compression to the spinal nerves and spinal canal to improve your symptoms. Mr Gomes performs a number of surgeries for this condition. This will be assessed and discussed at your consultation in order to choose which option is right for you.

  • Laminectomy – Removes the bony roof from the spinal canal creating more space for the nerves.

  • Lumbar Fusion – permanently connects two or more vertebrae in your spine. It is usually needed if there is severe disc degeneration associated with loss of height and/or subluxation (slippage between the vertebrae.) The kind of surgery needed to achieve fusion depends on patient factors such as anatomy, spinal level and symptoms. The technique used will be discussed in detail by Mr Keith Gomes.

    The options for surgery which may be able to be done as a keyhole approach include:
         PLIF – Posterolateral Lumbar Interbody Fusion
         TLIF – Transforaminal Lumbar Interbody Fusion
         ALIF – Anterior Lumbar Interbody Fusion

For all appointments and enquiries, please phone   03 8318 4929

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East Melbourne VIC 3002

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Suite 1A
262 Mountain Highway
Wantirna VIC 3151

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Moorabbin VIC 3189

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