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Lumbar Spinal Stenosis (Foot Drop)

  • What is lumbar spinal stenosis?

    Lumbar spinal stenosis

    Lumbar spinal stenosis occurs when the space around the spinal cord narrows, putting pressure on the cord and nerves that travel through the lower back into the legs. This can cause pain to radiate downwards as you walk.

    It is a progressive condition which occurs slowly, over many years, due to various causes such as spinal discs becoming less spongy with age or the growth of bone spurs, among others. As a result, it is more common in older people.

  • Arthritis (degeneration of a joint) is the most common cause of spinal stenosis. As the water content in our discs dry out with age, this leads to settling, or collapse, of the disc spaces and loss of disc space height. As a result, there is increased pressure on the facet joints and the protective layer of cartilage gets worn away.

    Other factors that contribute to lumbar spinal stenosis include:

    • Bony growths or bone spurs, which form in response to the wear and tear from osteoarthritis, which grow into the spinal canal. A condition called Paget’s disease can also lead to bony growths.
    • Herniated discs when discs crack, allowing its contents to escape and press on the spinal cord.
    • Thickening of ligaments, which happens over time, can bulge and intrude on the spinal canal.
    • Abnormal growths in the spinal cord, including cancer though this is rare.
    • Spinal injuries from accidents and other forms of trauma such as dislocations or fractures, and swelling that accompanies such injuries.

    You face a higher risk of developing lumbar spinal stenosis if you:

    • Are a woman
    • Are born with a narrow spinal canal
    • Are older than 50 years
    • Have had a past injury to the spine
    • Have a congenital or genetic disease that affects bone and muscle development
  • Symptoms of lumbar spinal stenosis include:

    • back pain
    • burning pain in the buttocks or legs (sciatica)
    • numbness or tingling in the buttocks or legs
    • tired and weak feeling in the legs when walking for prolonged periods, relieved by sitting
    • reduced pain when leaning forward or sitting
    • weakness in the legs or ‘foot drop’ (weakening of muscles that flex the ankle and toes)
  • Your doctor may begin with a discussion of your full medical history, a comprehensive physical examination, and a neurological evaluation to conclude if nerve damage is contributing to your symptoms.

    Depending on your condition, additional diagnostic tests such as an X-ray, CT/CAT scan or MRI, may also be necessary to get detailed pictures of the spine, and to confirm the diagnosis of spinal stenosis.

  • Treatment for lumbar spinal stenosis varies from patient to patient. Generally, non-surgical options are used first, with surgery advised only when other alternatives are proven unsatisfactory or unsuitable.

    Non-surgical treatments are limited to relieving symptoms and cannot reverse the narrowing of the spinal canal. This includes:

    • Physiotherapy
    • Anti-inflammatory medications; these must be used with care and medical supervision
    • Steroid (cortisone) injections
    • Acupuncture
    • Chiropractic care

    Spinal decompression surgery may be needed to create space for the compressed nerves and in addition, spinal fusion may be needed in cases of severe arthritis or a herniated disc which can result in excessive motion between vertebra, and in such cases, spinal fusion helps to stabilise the spin by permanently connecting two or more vertebrae.

    Surgical treatment may be advised for patients whose quality of life is severely impacted, such as being unable to walk for extended periods, or those who have found non-surgical treatments unsatisfactory in relieving their symptoms. The procedure is known as a laminectomy.

    Laminectomy, or decompression laminectomy, is a procedure that allows the surgeon to cut away the bony spurs, thickened ligaments or other growths that have compressed the nerves. It can be performed as an open surgery with one large incision or through small keyhole / minimally invasive incisions.

    This is performed while you are lying face-down, under general anaesthesia so you will be asleep during the procedure. The surgeon will make an incision in your back and gain access to the affected part of your vertebrae. Decompression laminectomy involves removing unwanted parts of the spine which are compressing on the nerves.

    After spinal decompression, bone grafts and screws may be placed if fusion is deemed necessary to stabilise the spine or to correct deformity.

    Consult an orthopaedic specialist to learn more treatment and management options for your spine condition.

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