Stenosis is caused, in many cases, due to the natural aging process which narrows the spinal cord. Just as lime builds up in your garden hose, the bones and ligaments of the spinal facet joints thicken and form arches that push into the spinal canal with advancing age. The spinal canal contains nerves that include the sciatic nerve, which provides sensation and support to the legs. A reduced diameter of the canal leads to compression of the nerves and causes sciatica.
Stenosis may occur anywhere in the different regions of the spinal column. Low back pain caused by a gradual deterioration of the vertebrae and the consequent narrowing of the lumbosacral spine is a prominent cause of morbidity and disability.
Stenosis of the lumbar spinal canal causes an arthritic pain of the lower back and legs that seems to be present over a large region and is often disabling. Severe lumbar stenosis may result in claudication – a disability to walking due to crippling legs or feet.
Medical treatment of lumbar stenosis involves the following:
- Bed rest
- Pain management
- Physical therapy, including exercise and yoga
- Sciatica alternative remedies like homeopathy, acupuncture and herbal therapy
As lumbar stenosis occurs mostly in middle-aged or elderly people, surgical treatment is done only after taking into account any related diseases that may be present. Usually the disability and discomfort experienced by patients is so high that they are eager to take the risks involved in surgery. Invasive sciatic nerve treatment for lumbar stenosis involves surgical decompression of the sciatic nerve by different types of surgical procedures:
- Standard surgical removal of the bony arches that form on the vertebrae (laminectomy) involves a midline incision over the affected level of the spine. The surgeon then removes the spine-like arches, extra bony layer and pedicles that are causing the compression.
- Lumbar stenosis usually occurs at more than one level, which requires the same procedure and a multilevel laminectomy is performed.
- Alternative surgical techniques can also be performed where multilevel laminotomy, which is a procedure that creates a new small opening (fenestra), is believed to minimize post operative complications.
- Newer invasive procedures involving complete removal and reattachment of vertebral arches and decompression of the space within the spinal canal (lateral recesses).
Irrespective of which procedure is performed, the success of surgical decompression depends upon the anatomical location of problem. An inadequate decompression often leads to incomplete relief from symptoms and to an increased risk of recurrence.
It is not always so that spinal stenosis causes symptoms in all those affected by it. Many people show significant signs of the condition in imaging tests but still show no signs of discomfort or disability. If the symptoms do occur, they can be extremely debilitating. In such cases, treatment becomes a priority.