Lumbar spinal stenosis
Definition and cause
Lumbar spinal stenosis corresponds to a gradual narrowing of the canal through which the nerves going to the lower limbs and perineum pass. This narrowing, or stenosis, is the result of osteoarthritis of the spine. As the osteoarthritis progresses, the tissues, and ligaments will collapse, and then bend into the canal. The joints between the vertebrae will deform and widen (osteophyte or parrot beak). Sometimes, the vertebrae will even progressively slip in relation to each other (degenerative spondylolisthésis , scoliosis, or dislocation).
Course of the disease
The nerves will adapt to this narrowing during the first period of this condition, which can remain totally silent for years. Then, starting from a certain degree of stenosis, the nerve involvement will manifest itself through pain and/or difficulty walking.
There is currently no treatment to prevent osteoarthritis of the spine from developing, or even to slow down its progress; therefore, there is no treatment to be implemented until the person is suffering from lumbar spinal stenosis. Once the symptoms appear, medical treatment will combine analgesic and anti-inflammatorydrugs, and sometimes massages or infiltrations. The aim of this treatment is to calm the inflammation around the compressed nerve roots and to achieve a possible resolution of the episode. However, the general trend is toward progressive worsening, often over several years. Based on the course of the disease, the physician and the patient will get an idea about the effectiveness of this treatment and seek a surgical opinion if it is not effective.
Principle of surgical treatment
If progress is not good, the surgeon, based on the severity of the patient’s symptoms, the duration of the disease, and the severity of the lumbar spinal stenosis, will decide whether or not surgery is necessary to decompress the affected nerve roots. This is a surgery that is performed through the back. The aim is to remove a portion of the back part of the vertebra (laminectomy) to restore sufficient space for the nerve roots and to allow the spine to continue its aging process without leading to new compressive phenomena. In case of instability between the vertebrae, it is essential to supplement this nerve release with reinforcement of the spine (osteosynthesis) to stop vertebral slipping.
Average hospitalization time
3 to 7 days (these are the durations most often reported)
A minimum 4- to 6-week recovery period is essential following the surgery. Based on the severity of symptoms before the procedure, this period may be longer. Recovery is not synonymous with bed rest. Physical exertion, carrying loads, and car trips must be limited during this period. Walking is often beneficial. Recurrence of pain during recovery is often the result of too much activity and will tend to disappear with rest.