Lumbar Spinal Stenosis

Lumbar spinal stenosis is a condition characterized by pain radiating to the legs, numbness, and limited walking ability due to the narrowing of the canal through which the spinal cord and nerve roots pass. Quality of life can be improved with early diagnosis, appropriate physical therapy, and surgical options when necessary.

What is Lumbar Spinal Stenosis?

Spinal stenosis occurs when the nerve tissue becomes compressed due to the narrowing of the spinal canal caused by thickening and bulging of bone, disc, or ligamentous tissues. Age-related degeneration is the most common cause; congenital narrow canal, trauma, or post-surgical changes can also be contributing factors.

Causes of Lumbar Spinal Stenosis

• Degenerative disc disease and facet joint arthritis
• Thickening of the ligamentum flavum
• Spinal slippage (spondylolisthesis)
• Congenital narrow canal
• Trauma, post-surgical fibrosis
• Calcification and bone spurs (osteophytes)

Symptoms of Lumbar Spinal Stenosis

• Pain radiating from the low back to the hip and leg (neurogenic claudication)
• Pain that increases with walking and decreases with leaning forward
• Numbness, tingling, loss of strength
• Inability to stand for long periods
• In advanced cases, balance disorder and a tendency to fall

When should you see a doctor?

You should consult a doctor without delay if your pain persists for more than 6 weeks, your walking distance has shortened, you experience progressive leg weakness, bladder or bowel dysfunction, or pain that wakes you up at night.

Diagnostic Methods

• Clinical examination and neurological assessment
• X-ray for evaluation of alignment/calcification
• MRI to demonstrate canal narrowing and nerve compression
• CT/CT-myelography to detail the bone structure
• EMG to determine the degree of nerve involvement

Treatment Options

Physical Therapy and Rehabilitation

• Manual therapy and mobilization: Increases joint range of motion and reduces muscle spasm.
• Neurodynamic exercises: Relieves nerve compression through nerve gliding and stretching techniques.
• Flexion-focused exercises: Reduces pressure within the canal by strengthening forward-bending patterns.
• Core stabilization and hip strengthening: Balances load distribution between the back and legs, increasing walking distance.
• Posture and gait training: Corrects pain-inducing patterns like walking downhill or taking long strides.
• Traction and electrotherapy (in selected cases): Provides support for pain modulation and functional improvement.

Note: Physical therapy yields the best results when combined with medication and lifestyle changes; the treatment duration is usually planned as 2–3 sessions per week for 6–8 weeks.

Medication Treatment

• Pain and inflammation control with paracetamol or NSAIDs
• Gabapentinoids or SNRIs for neuropathic pain (if deemed appropriate by the physician)
• Short-term muscle relaxants (in selected circumstances)

Interventional and Surgical Methods

• Epidural steroid injection: Can reduce pain in the short to medium term.
• Decompression surgery (laminectomy, microscopic decompression): For persistent nerve compression.
• Instrumentation/fixation: May be added if there is accompanying instability or slippage.

Lifestyle and Exercise Recommendations

• Weight control, anti-inflammatory nutrition
• Daily short walks, cardio activities that tolerate forward leaning such as cycling/elliptical machine
• Avoiding prolonged standing, planning activities with breaks
• Regular adherence to a home exercise program, avoiding smoking