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What is Lumbar Spinal Stenosis and Myelopathy?
The lumbar spine (lower back) consists of a series of bones connected to each other. The bones circumscribe the spinal canal through which the spinal cord passes. Other structures that form the borders of the spinal canal are intervertebral discs, facet joints, and connective tissues (ligamentum flavum).
With advancing age, the discs between the vertebra begin to lose their spongious structure and their water content decreases. This condition leads to a decrease in disc height and bulging of the hardened disc into the spinal canal. The spinal cord carries the nerves that give sensation and power to the legs. The thickening of the bones and ligaments of the facet joints due to arthritis (loss of cartilage tissue) may also cause pressure on the spinal canal. These changes result in the narrowing of the spinal canal, and this condition is named "spinal stenosis" or "narrow canal".
What Are Symptoms?
Narrow canal does not always cause symptoms. In many people, despite the presence of significant narrowing proven by MRI, there may be no complaints.
Possible symptoms include loss of sensation or power in the legs or leg cramps. In rare instances,problems with bladder and intestinal control may occur. The symptoms worsen with prolonged periods of sitting or standing. The symptoms may fluctuate and their intensities may vary. Bending forward or sitting will increase the diameter of the spinal canal, and enable a decrease or total disappearance of pain. The most typical symptom is pain and weakness in the leg after walking for a distance. Sensory changes may also occur during walking. Sitting and leaning forward relieves leg pain and patients continue walking. However, the same symptoms come back after walking for a while.
How is it Diagnosed?
After asking questions about your illness, your doctor will examine you and order the necessary tests.
X-rays may reveal decreased disc spaces or thickened facet joints. Today, narrowing in the spinal canal and compression of the spinal cord can be shown in detail using MRI, which is the gold standard. CT or lumbar myelogram can be used for similar purposes. Each of these studies may provide information on the constriction of the spinal canal and the presence, location, and severity of nerve root compression.
A stepwise treatment algorithm is applied for the treatment of lumbar stenosis.