Lumbar Canal Stenosis

There are two main types of lumbar canal stenosis:

• Central canal stenosis occurs when the main spinal canal narrows.
• Foraminal stenosis occurs when the small openings (foramina) where nerves exit the spine become narrow.

People with lumbar canal stenosis may notice a combination of pain, weakness, and reduced mobility:

• Pain in the lower back that spreads to one or both legs. The pain often increases when standing or walking (called claudication) and improves with rest.
• Stiffness that reduces flexibility and mobility in the lower back.
• Weakness or numbness in the legs, which may be mild at first but can worsen over time.
• Problems with bowel or bladder control in the advanced cases, which require urgent medical attention.

Lumbar canal stenosis develops due to several reasons:

• Ageing, which leads to wear and tear of the spinal bones, ligaments, and discs.
• Disc problems, such as herniated or bulging discs that press on the nerves.
• Thickening of ligaments around the spine, which narrows the spinal canal.
• Bone spurs that develop as part of arthritis or degeneration.
• Previous spine injuries or surgeries.

Doctors use a combination of clinical examination and imaging to diagnose lumbar canal stenosis:

• Taking a detailed medical history to understand symptoms and their progression.
• Examining the lower back through palpation, range of motion checks and neurological testing.
• Performing specific tests, such as straight leg raise test, to detect nerve compression.
• Assessment of movements and neurological examination.
• Ordering X-rays to assess disc space, degenerative (wear and tear) changes, fractures, or loss of curvatures.
• Using magnetic resonance imaging (MRI) to check canal size, disc condition, and nerve compression.
• Nerve conduction velocity and electromyographical to assess how well the nerve roots and muscles are working.

Based on the intensity of the patient’s symptoms, one or more of the following treatment approaches can be used:

• Non-surgical treatment methods aim to provide pain relief and restore the function of the lower back:
  • Non-steroidal anti-inflammatory medications help reduce pain and swelling.
  • Rest and short-term activity modification may ease symptoms.
  • Ice pack application helps reduce local pain and inflammation.
  • Physical therapy strengthens the core and back muscles to improve support and stability.
  • Steroid injections around the nerves can reduce swelling and relieve pain.
• Surgical treatment may be required when non-surgical do not provide relief or when symptoms such as weakness and numbness worsen:
  • Decompression surgery involves releasing the pressure on the affected nerve roots by making small openings in the bone.
  • Decompression and fusion involves releasing the compression on the nerve and addressing the bony instability using screws and rods.
  • Spine rehabilitation services are recommended for rapid recovery in patients undergoing surgery.

You should see a doctor if you have persistent lower back pain that spreads to the legs, if walking or standing becomes difficult, or if you notice numbness, weakness, or loss of bowel or bladder control.

While lumbar canal stenosis cannot always be prevented, some steps may reduce the risk:

• Maintaining good posture while sitting, standing, and lifting.
• Staying active with regular low-impact exercises, such as swimming or cycling.
• Strengthening the core and back muscles to support the spine.
• Maintaining a healthy weight to reduce strain on the lower back.

If you suspect lumbar canal stenosis, you should consult an orthopaedic spine specialist or a neurosurgeon. A physiotherapist can also help manage symptoms with targeted exercises and posture correction.