Lumbar spinal stenosis

Lumbar spine osteoarthritis

Nowadays, a large number of elderly people suffer from spinal canal stenosis due to lumbar osteoarthritis.

What is lumbar spinal stenosis?

The spine is made up of vertebrae with a canal in their center: the spinal canal.


This contains the spinal cord and nerves. At the lumbar level, the spinal cord ends, and the canal contains only the nerves known as the "cauda equina," which innervate the lower limbs and perineum.



This canal is generally wide enough to easily transport all the nerve roots. Depending on the individual patient's constitution, or due to degenerative conditions such as osteoarthritis, a narrowing of the spinal canal may occur. This is known as lumbar spinal canal stenosis.

What are the symptoms of lumbar spinal stenosis?

Lumbar osteoarthritis will trigger compression of the nerve elements located within the spinal canal and will cause the following signs:


  • Difficulty walking: Typically, at the beginning of walking, everything is normal, but pain, a feeling of fatigue and weakness in the lower limbs, a stiffness, tingling, and stabbing pain in the legs gradually appear; these symptoms will quickly stop walking. Then, gradually and with rest, these sensations disappear, the pain lessens, and walking can be resumed, but they will quickly reappear after starting walking.


  • Pain in the lower limbs (sciatica) that appears both at rest and during exertion.


  • Theoretically, it is possible, although very rare, for a more or less significant paralysis of the lower limbs or sphincter functions to appear.

    • What treatment is indicated for lumbar osteoarthritis?

    The symptoms of spinal canal stenosis can always be alleviated by conservative medical treatment, such as anti-inflammatories, analgesics, and injections, whether or not associated with physical therapy.


    The determining element that can decide an intervention is therefore tolerance of this situation.


    Only surgical intervention can increase the diameter of the spinal canal.


    There's no major drawback to waiting. The risk of paralysis is rare, and postponing surgery doesn't alter the expected outcome. Surgery is often proposed when the patient has undergone extensive medical treatment without satisfactory results.

    

    Does lumbar osteoarthritis require surgery?

    Although there is no urgency to operate, surgery is indicated in the following cases:


  • Motor deficit (paralyzing sciatica)


  • Intolerable pain that does not improve with morphine.

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  • Cauda equina syndrome (problems in the perianal region, sphincter dysfunction, particularly the urinary sphincters)

    • What is spinal stenosis surgery like?

    The purpose of surgery is to relieve compression of the nerve elements. To do this, it will be necessary to remove the tissue obstructing the canal (bone formations, joint surfaces, ligaments, and parts of the intervertebral discs).


  • The procedure is performed under general anesthesia. A radiological assessment of your posture is performed under image amplification control, allowing the location of the canal planned for the procedure and the incision site to be located.


  • The skin incision is made in the dorsal region; its size will depend on the number of levels to be treated and whether or not the vertebrae need to be fixed. Once the incision is made, the surgeon will separate the muscles of the lumbar region to access the lumbar canal. Surgical procedures may vary depending on the type of stenosis. Depending on the diagnosis, clinical examination, and radiographic findings, the operation will involve removing fragments of bone or joints, ligaments, or the herniated disc. Each case is therefore unique, and the procedures will be explained by your surgeon.

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  • These release of the nervous elements is the basic gesture.

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