This common condition occurs when the space available for the nerves in the lumbar spine is too small, and this limits the conduction of nerve signals to the leg. It leads to pain and numbness that radiates into the legs, and can be present when resting, or may only occur when walking for a certain distance. Often people find relief when walking with a shopping trolley or gait aid. It is also a common cause of lower back and buttock pain.
The condition is usually chronic, and is caused by degeneration of the lumbar vertebral discs as well as arthritis of the facet joints at the back of the spinal canal – together these lead to narrowing of the spinal canal. There can also be slippage of one vertebrae in relation to the next vertebrae, called spondylolisthesis, and this can further compress the spinal canal as well as the exiting nerve roots.
Spinal canal stenosis can also occur as an acute problem with a large disc prolapse, tumour, trauma or facet joint cyst. If this is large enough you can present with cauda equina syndrome which is a surgical emergency and you should present immediately to the emergency department for treatment.
MRI is the gold standard for diagnosing this condition, as it allows excellent visualisation of the nerves and discs. However, when deciding on appropriate treatments there will often be a need for other investigations such as xray, CT scan and bone scan. Dr Anderson will discuss this with you during your appointment and will make sure that he only orders appropriate tests that will impact on the management of your condition.
Often patients get relief from non-surgical treatment, and this is the first option for the majority of patients. A combination of physiotherapy, hydrotherapy, core strengthening and weight management strategies are commonly very effective. This is used in conjunction with appropriate analgesia, targeted steroid injections, and occasionally other alternative therapies. Often you will be referred for help from another medical or allied health practitioner and Dr Anderson will go through these options with you.
Surgical management may be recommended if you have tried non-surgical treatments and they have not given you enough relief from your symptoms. There are certain factors that make one treatment recommended over others, but in general the options include surgical decompression (laminectomy, discectomy) or fusion (posterior interbody fusion, anterior interbody fusion, lateral interbody fusion, or a combination of these) procedures.