The term lumbar canal stenosis refers to a narrowing of the canal in the lower back area through which the roots that form the nerves of the legs must pass. The most common is that the canal is constricted by the natural aging of our spine. For this reason, it is an injury that usually affects people over 60 years. Other common causes of narrowing of the channel are spondylolisthesis, which we will explain in future posts, and trauma. Then we have other more rare causes like some congenital, rheumatic and tumors.
Channel StenosisLet’s tell what happens when this channel narrows. To do this you have to explain some things. Within the canal that runs the entire spine is the spinal cord. This marrow is the continuation of our brain and will end when we reach the first lumbar vertebra. Once the marrow is finished, only the nerve roots leaving it remain. These roots form what is called the ponytail. The name is very descriptive of how they are arranged. The roots form like a bouquet of nerves that descend through the lumbar region of the spine.
When the lumbar canal narrows, these nerve roots will suffer the consequences because they will not fit well. There is a space problem for them. The typical symptom of this type of injury is the need to stop walking because the legs do not respond to us. It is what we call “claudicación”. This sensation can be accompanied by heaviness in the legs, tingling and sometimes notice lack of sensitivity. Also typical is the pain in the lower back when we are standing and the absence of pain when we are sitting.
The person who suffers from lumbar canal stenosis is worse off when standing erect and improves when leaning forward or when sitting. If we look at the shape of the lumbar spine we will understand. If we are standing the channel forms a curve due to the overlap of the joints in the back. If we sit down and the curve corrects to become a straight channel, the roots will have more space.
If we have these signs, our doctor will probably ask us for an imaging test, especially MRI. Being an anatomical defect we will see well with this test. We can see the area that has narrowed. That being said one would think that the only solution would be to remove that narrowness with a surgical intervention. The reality is not this, I explain. The column is not a static structure, it moves. The cause of increasing symptoms is usually not that the stenosis has increased, but there are other causes added. It occurs as in chronic low back pain ; The pain causes a worsening of the strength of the muscles that stabilize the lower back. If we do not have sufficient strength there will be more instability in this area and the nerves will suffer more compression.
The problem can be addressed in many ways but there are three key things to improve in the medium term:
– Gain flexibility in the lower back.
– Recover and increase the strength and endurance of the muscles of the back.
– Learn all those attitudes that are bad for the back.
On the web we can find how to carry out all of them. This is the key but there are other treatments that can help us, such as treatment at the hands of a physiotherapist, medications or an epidural infiltration.
Fortunately surgery is rarely necessary. When will surgery be necessary? A possible surgery is considered when the symptoms are invalidating and they spend many months and we cannot improve with other treatments. If our quality of life has worsened and we cannot make a normal life and no other treatment works, it seems reasonable to raise this possibility. Very occasionally it is necessary to operate urgently. This is done when there are serious injuries to the growing nerves, which we call horsetail syndrome. This is very rare when we talk about the natural wear of the back. Yes it is more frequent when we speak of tumors or of major traumatisms.