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lumbar-spineThe lumbar spine is made up of five vertebral bodies in the lower back, where the spine curves inward toward the abdomen. It starts about five or six inches below the shoulder blades, and connects with the thoracic spine at the top and extends downward to the sacral spine. These nerves transmit sensations from the buttocks and lower extremities through the spinal cord to the brain and transmit motor signals from the brain to the lower extremities to produce movement of the legs, toes, and joints of the lower extremities.

Lumbar Stenosis

Lumbar spinal stenosis is a condition caused by narrowing of the spinal canal. This narrowing occurs when the growth of bone or tissue or both reduces the size of the openings in the spinal bones. This narrowing can squeeze and irritate the nerves that branch out from the spinal cord.

Causes

  • Back injuries: Can both cause spinal stenosis or can worsen already existing low-level symptoms.
  • Tumor growth: Can narrow the spinal canal, but the occurrence of spinal tumors is rare.
  • Bone spurs: As cartilage deteriorates between the joints of the back, small bone growths, called bone spurs, or osteophytes, can develop. Bone spurs sometimes develop due to arthritis in the spine.
  • Herniated discs: As the discs in the back deteriorate they can herniate, meaning the disc swells, bulges, or ruptures. When this occurs, some of the disc material can protrude into the spinal canal. A herniated disc, while painful, doesn’t always cause lumbar spinal stenosis.
  • Changes to ligaments: Changes can occur, especially to the ligament flavum, the ligament that runs along the inside of the spinal canal. This ligament can become thickened, taking up more space in the spinal canal. Or, as deteriorating discs lose some of their height, this ligament can buckle.
  • Enlarged facet joints: Enlargement of the facet joints in the spine can also cause narrowing of the spinal canal.
  • Spondylolisthesis: Refers to the forward slippage of one vertebra over another in the spine. It can cause narrowing of the spinal canal and result in pinching of the nerves. Learn more about spondylolisthesis.

lumbar_stenosisSymptoms

  • Back pain: People with spinal stenosis may or may not have back pain, depending on the degree of arthritis that has developed.
  • Burning pain: Pressure on spinal nerves can result in pain in the areas that the nerves supply. The pain may be described as an ache or a burning feeling. It typically starts in the area of the buttocks and radiates down the leg. The pain down the leg is often called “sciatica.” As it progresses, it can result in pain in the foot.
  • Numbness: As pressure on the nerve increases, numbness and tingling often accompany the burning pain. Although not all patients will have both burning pain and numbness and tingling.
  • Weakness or “foot drop”: Once the pressure reaches a critical level, weakness can occur in one or both legs. Some patients will have a foot-drop or the feeling that their foot slaps on the ground while walking.
  • Pain with leaning forward or sitting: Studies of the lumbar spine show that leaning forward can increase the space available for the nerves. Many patients may note relief when leaning forward and especially with sitting. Pain is usually made worse by standing up straight and walking. Some patients note that they can ride a stationary bike or walk leaning on a shopping cart. Walking more than 1 or 2 blocks, however, may bring on severe sciatica or weakness.

lumbar-spinal-stenosis-treatmentTreatment

  • Laminectomy: This procedure involves removing the bone, bone spurs, and ligaments that are compressing the nerves. This procedure may also be called a “decompression.” Laminectomy is a surgical procedure to remove a portion of the vertebral bone called the lamina. The minimal form of the procedure requires only small skin incisions, the back muscles are pushed aside rather than cut, and the parts of the vertebra adjacent to the lamina are left intact. Recovery from the minimal procedure can occur within a few days.
  • Spinal fusion: If arthritis has progressed to spinal instability, a combination of decompression and stabilization or spinal fusion may be recommended. Spinal fusion is a surgical procedure used to correct problems with the small bones of the spine (vertebrae). It is essentially a “welding” process. The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone.
  • Lumbar traction: Although it may be helpful in some patients, traction has very limited results. There is no scientific evidence of its effectiveness.
  • Steroid injections: Cortisone is a powerful anti-inflammatory. Cortisone injections around the nerves or in the “epidural space” can decrease swelling, as well as pain. It is not recommended to receive these, however, more than three times per year. These injections are more likely to decrease pain and numbness but not a weakness of the legs.

Spinal Tumors

A spinal tumor, also termed as neoplasm’s that is seen to be a cancerous or a noncancerous growth which develops within or near the spinal cord area or within the bones of the spine. The common areas where these tumors occur are cervical, thoracic, lumbar and sacrum.Tumors that start in the spinal tissue are termed as primary spinal tumors. On the other hand, the tumors that spread in the spine through some other body organ are termed as secondary spinal tumors.Back pain is seen to be the most common symptom of a spinal tumor. Such sort of a tumor or an unaccepted growth of tissues that can affect the nerves where the tumor has developed. Such growth can be very critical and can cause permanent disability or sometimes even death.

Symptoms of Spinal Tumors

The symptoms that any patient can face depend on the location, type and the general health condition of the patient. Secondary tumors also are known as (Metastatic Tumors)have been seen progressing quickly. Primary tumors, on the other hand, might take months or maybe years to grow and develop.
Patients suffering from spinal tumors are seen to have certain complications that
are:

lumbar-spinal-stenosis1. Abnormal sensations or loss of sensation:
a. Causes usually in the legs which include knee and ankle
b. Cold sensation in the legs, cold fingers and hands

2. Back pain:
a. Middle and lower back are most common pints of pain
b. Usually, the pain isn’t relieved even after taking medications.
c. Patients suffer strain, cold, cough and continuous sneezing

3. Fecal incontinence
a. Leads to the inability of keeping oneself from holding urine.

4. Muscle contractions:
a. Leads to complications like twitches and spasms

5. Muscle is weakening
a. Leads to difficulty in walking
b. Causes fall
c. Severe sprains

Treatments

To diagnose the problems of the patients the regular series of tests may include a neurological examination, spinal tumor X-rays, MRI, CT scans and a closed biopsy may be considered as necessary to plan a definitive treatment. The three most common treatments that are usually undertaken to treat the patients are.

Corticosteroids (Dexamethasone)

This treatment is given to reduce inflammation along with swelling in the spinal cord region

Surgeries:
Surgery can be done with a view to reduce the compression of the spinal cord. Some tumors are completely removed using surgeries whereas others are partially removed to relieve the pressure on the spine.

Radiation therapy:
May be used on its own or in combination with the surgery to treat the complication.

Chemotherapy:
Though this procedure has not seen many successes but still depending from case to case, it is still
recommended by the doctors.

Physical therapy:
Is used to improve the muscle strength and to make it capable of working independently.