Lumbar stenosis is a degenerative disease affecting the spine. Our expert in Orthopedics and Traumatology at Paternò (Catania) , Prof. Gaetano Gulino, speaks to us about symptomatology and the two therapeutic approaches
What is stenosis ?
Lumbar stenosis is characterized by abnormal tightness of the bone vertebral canal and / or conjugate boreholes that are responsible for compression of the dural bag, spinal cord covering, and / or nerve roots. It can be congenital, and in this case modest degenerative vertebral alterations can cause compression of the nerve structures contained in the channel, or secondary when the channel, of primitive amplitude usually normal, is restricted by marked arthritic alterations of the interphysical joints or vertebral bodies. Often lumbar stenosis is due to the combination of the two forms, congenital and secondary.The abnormal tightness of the vertebral canal causes venous congestion with edema of the nerve root and consequently a decrease in the microcirculation of the nerve structures of the cauda equina, namely the particular structure of the spinal nerves. Lumbar stenosis mainly occurs with a cramping pain in the lower limbs ( leg pains ) that forces the patient to stop during walking (sometimes after only a few dozen meters) and is called "claudicatio neurogena".
Lumbar stenosis: symptoms
Patients complain of a symptom characterized by fatigue, pain and lower limb sensitivity disorders which accentuates during the extension of the vertebral column and it regresses with the forward flexion. Patients find comfort when sitting or riding a bike, because in these flexural postures of the lumbar spine there is an increase in the anterior-back diameter of the vertebral canal and hence more room and better microcirculation for the nerve structures.Patients may present themselves with the flex flank forward (a position that relieves the pain) and painful limitation of the lumbar spine articular movements. There are rarely deficiencies in muscular strength of the lower limbs, whereas sensitivity disorders are more commonly present. Deep osteotendense reflexes may be normal or impeccable, never hypersensitive. In cases where a refractive hyperexcitability is manifested, the instrumental diagnostic study (Nuclear Magnetic Resonance, Sensitive Somni Potentials Potential, Neurophysiological Method to Measure Nerve Run) should be directed towards the cervical spine and dorsal spine to exclude a medullary lesion. Rarely, although described in the literature, caudal syndrome may be associated with acute or chronic loss of bladder and rectal sphincter functions. Canal stenosis may also involve the cervical canal, and in these cases patients also exhibit signs of cervical myelopathy in addition to clinical signs of lumbar stenosis.
Differential diagnosis for lumbar stenosis
Diabetic neuropathy (lack of sensitivity distributed to glove) and vascular claudication (cold feet, absence of peripheral wrists) should be considered.. For differential diagnosis with vascular claudication it becomes useful to investigate the ability to ride bicycles other than walking. While patients with vascular claudication exhibit symptoms both during walking and when cycling, patients with vertebral canal stenosis present claudication only during walking and never during bicycle use.
Lumbar stenosis: conservative treatment
Most patients with lumbar spine stenosis respond to conservative treatment, as appropriate pharmacological therapy (Fans, corticosteroids, muscle relaxants, etc.) and a proper physical therapy program (stretching and muscle strengthening exercises) help alleviate painful symptomatology. Subsequently, when acute pain is regressed, an aerobic exercises program (walking, cycling and exercises in the water) contributes to a further regression of the symptoms. 10-15% of patients with canal stenosis do not respond to conservative treatment, and only in these cases surgical treatment becomes necessary.
Lumbar stenosis: surgical treatment
The surgical procedure includes decompression of the nerve structures by laminectomy (removal of one or more vertebral layers), sometimes associated with stabilization of the vertebrae, especially in cases where it was necessary to remove bone parts important for spine stability and in cases of instability or pre-existing vertebral slip.Well-performed surgical treatment provides excellent results, as most patients return to having a satisfactory quality of life while also taking on sports and work.