Lumbar-spinal-stenosis escoliosis de convexidad izquierda

These bones connect to create a canal that protects the spinal cord. The spinal column is made up of three sections that create three natural curves in your back: the curves of the neck area (cervical), chest area (thoracic), and lower back (lumbar). The lower section of your spine (sacrum and coccyx) is made up of vertebrae that are fused together.

When stenosis occurs in the lower back, it is called lumbar spinal stenosis. It often results from the normal aging process. As people age, the soft tissues and bones in the spine may harden or become overgrown. These degenerative changes may narrow the space around the spinal cord and result in spinal stenosis.

Degenerative changes of the spine are seen in up to 95% of people by the age of 50.


Spinal stenosis most often occurs in adults over 60 years old. Pressure on the spinal cord is equally common in men and women, although women are more likely to have symptoms that require treatment.

In the spine, arthritis can result as the disk degenerates and loses water content. In children and young adults, disks have high water content. As we get older, our disks begin to dry out and weaken. This problem causes settling, or collapse, of the disk spaces and loss of disk space height.

As the facet joints experience increased pressure, they also begin to degenerate and develop arthritis, similar to the hip or knee joint. The cartilage that covers and protects the joints wears away. If the cartilage wears away completely, it can result in bone rubbing on bone. To make up for the lost cartilage, your body may respond by growing new bone in your facet joints to help support the vertebrae. Over time, this bone overgrowth-called spurs-may narrow the space for the nerves to pass through.

Burning pain in buttocks or legs (sciatica). Pressure on spinal nerves can result in pain in the areas that the nerves supply. The pain may be described as an ache or a burning feeling. It typically starts in the area of the buttocks and radiates down the leg. The pain down the leg is often called "sciatica." As it progresses, it can result in pain in the foot.

Less pain with leaning forward or sitting. Studies of the lumbar spine show that leaning forward can actually increase the space available for the nerves. Many patients may note relief when leaning forward and especially with sitting. Pain is usually made worse by standing up straight and walking. Some patients note that they can ride a stationary bike or walk leaning on a shopping cart. Walking more than 1 or 2 blocks, however, may bring on severe sciatica or weakness.

After discussing your symptoms and medical history, your doctor will examine your back. This will include looking at your back and pushing on different areas to see if it hurts. Your doctor may have you bend forward, backward, and side-to-side to look for limitations or pain. Imaging Tests

Additional tests. Computed tomography (CT) scans can create cross-section images of your spine. Your doctor may also order a myelogram. In this procedure, dye is injected into the spine to make the nerves show up more clearly. It can help your doctor determine whether the nerves are being compressed.

Anti-inflammatory medications. Because stenosis pain is caused by pressure on a spinal nerve, reducing inflammation (swelling) around the nerve may relieve pain. Non-steroidal anti-inflammatory drugs (NSAIDs) initially provide pain relief. When used over the course of 5-10 days, they can also have an anti-inflammatory effect.

Most people are familiar with nonprescription NSAIDs, such as aspirin and ibuprofen. Whether over-the-counter or prescription strength, these medicines must be used carefully. They can lead to gastritis or stomach ulcers. If you develop acid reflux or stomach pains while taking an anti-inflammatory, be sure to talk with your doctor.

Steroid injections. Cortisone is a powerful anti-inflammatory. Cortisone injections around the nerves or in the "epidural space" can decrease swelling, as well as pain. It is not recommended to receive these, however, more than 3 times per year. These injections are more likely to decrease pain and numbness but not weakness of the legs.

Chiropractic manipulation. Chiropractic manipulation is generally safe and can help with some of the pain from lumbar stenosis. Care should be taken if a patient has osteoporosis or disk herniation. Manipulation of the spine in these cases can worsen symptoms or cause other injuries. Surgical Treatment

Surgery for lumbar spinal stenosis is generally reserved for patients who have poor quality of life due to pain and weakness. Patients may complain of inability to walk for an extended length of time without sitting. This is often the reason that patients consider surgery.

Laminectomy. This procedure involves removing the bone, bone spurs, and ligaments that are compressing the nerves. This procedure may also be called a "decompression." Laminectomy can be performed as open surgery, where your doctor uses a single, larger incision to access your spine. The procedure can also be done using a minimally invasive method, where several smaller incisions are made. Your doctor will discuss with you the right option for you.

Fusion eliminates motion between vertebrae and prevents the slippage from worsening after surgery. The surgeon may also use rods and screws to hold the spine in place while the bones fuse together. The use of rods and screws makes the fusion of the bones happen faster and speeds recovery.

Rehabilitation. After surgery, you may stay in the hospital for a short time, depending on your health and the procedure performed. Healthy patients who undergo just decompression may go home the same or next day, and may return to normal activities after only a few weeks. Fusion generally adds 2 to 3 days to the hospital stay.

Your physical therapist may show you exercises to help you build and maintain strength, endurance, and flexibility for spinal stability. Some of these exercises will help strengthen your abdominal muscles, which help support your back. Your physical therapist will create an individualized program, taking into consideration your health and history.

Most people can go back to a desk job within a few days to a few weeks after surgery. They may return to normal activities after 2 to 3 months. Older patients who need more care and assistance may be transferred from the hospital to a rehabilitation facility prior to going home.

Surgical outcomes. Overall, the results of laminectomy with or without spinal fusion for lumbar stenosis are good to excellent in approximately 80% of patients. Patients tend to see more improvement of leg pain than back pain. Most patients are able to resume a normal lifestyle after a period of recovery from surgery.

Interspinous process devices have been developed as a minimally invasive surgical option for lumbar spinal stenosis. A spacer fits between the spinous processes in the back of the spine. Its role is to keep the space for the nerves open by spreading the vertebrae apart.

The key to success with this procedure is appropriate selection of the patients. The appropriate candidate must have relief of buttock and leg pain when sitting or bending forward. The pain returns upon standing. Minimally Invasive Decompression

With these minimally invasive techniques, surgeons rely more on microscopes to see the area for surgery. They may also take X-rays during the operation. A traditional open procedure requires more direct visualization of the patient’s anatomy, and therefore requires a larger incision. This can be more painful for the patient.

The advantages of minimally invasive procedures include reduced hospital stays and recovery periods. However, both open and minimally invasive techniques relieve stenosis symptoms equally. Your doctor will be able to discuss with you the options that best meet your healthcare needs.