UNC Health Talk

Relieving the Pain of Lumbar Spinal Stenosis

Omar McLaughlin first began having lower back pain when he was 18 or 19. Over the years, that pain, along with numbness and tingling, gradually moved down to his legs and greatly limited what he was able to do.

“I couldn’t walk long distances like I used to anymore,” McLaughlin says. “And it wouldn’t ease up. It just kept getting worse.”

In an attempt to relieve the pain, numbness and tingling, his doctors prescribed muscle relaxing medications, injections and physical therapy. All of these gave him some temporary relief, McLaughlin says, but none of them provided a permanent solution.

By 2020, McLaughlin was in his early 40s and began talking with Douglas S. Weinberg, MD, a spine specialist at UNC Health, about surgery to correct the root cause of his problems: lumbar spinal stenosis, a narrowing of the spinal canal.

Lumbar spinal stenosis is one of the most common problems associated with the normal wear and tear of aging on the spine. It sometimes happens in younger people but occurs most commonly in people over the age of 60. It affects about 5 percent of the population. Unlike McLaughlin, most people with symptomatic spinal stenosis are treated without surgery.

In McLaughlin’s case, Dr. Weinberg diagnosed him with congenital lumbar spinal stenosis, meaning he was born with a narrower spinal canal.

To correct McLaughlin’s spinal stenosis, Dr. Weinberg performed a lumbar laminectomy. This is a type of surgery in which the surgeon removes some or all of the vertebral bone, called the lamina, in part of the spine. This helps ease the pressure on the spinal cord and the nerve roots that is caused by narrowing of the spinal canal.

Six months after his surgery, McLaughlin says, his pain and other symptoms are gone. “Now I can run and play with my kids again,” he says.

The Basics: Lumber Spinal Stenosis

“The term ‘stenosis’ means narrowing,” Dr. Weinberg says. “You can have stenosis of the nerves in the neck or stenosis of the nerves in the back. A patient’s clinical picture and symptoms are dependent on the type of stenosis they have.”

When stenosis happens in the neck, that’s called cervical spinal stenosis. When it happens in the lower back, it’s called lumbar spinal stenosis.

As people reach age 50 and beyond, most experience arthritis, or degeneration of the joints in the spine. As the arthritis progresses, so does the narrowing of the spinal canal, the hollow passage through which the spinal cord and nerves travel. When the spinal canal narrows, that makes it more difficult for electrical signals to travel from the brain to other parts of the body.

“I like to use the analogy that the spinal cord is the main highway for information in your body,” Dr. Weinberg says. “When there is an obstruction on that highway, nothing is able to pass through until something is done to clear the way.”

For people with lumbar spinal stenosis, symptoms can include:

  • Back pain
  • Leg pain while walking
  • Burning pain in the buttocks or legs
  • Numbness or tingling in the buttocks or legs
  • Weakness in the legs (some also experience foot drop, the feeling that their foot slaps the ground while they are walking)
  • Having less pain while leaning forward or sitting

Some people with spinal stenosis don’t have symptoms and don’t require treatment.

Treatment Options for Lumbar Spinal Stenosis

Lumbar stenosis has two different clinical manifestations, Dr. Weinberg says. The first is called lumbar radiculopathy, which is caused by compression of a single nerve in the back.

Many patients with lumbar radiculopathy can be treated effectively without surgery, Dr. Weinberg says. Options include nonsteroidal, anti-inflammatory medications (NSAIDs) such as aspirin or ibuprofen, physical therapy and epidural steroid injections.

The second type of lumbar stenosis is called neurogenic claudication. This affects multiple nerves in the legs, not just one specific nerve.

“We see neurogenic claudication most often in older individuals, and this often manifests with symptoms such as difficulty walking and pain in the legs with walking,” Dr. Weinberg says. “These patients sometimes say they feel like their legs just give up on them.”

Whatever the type of lumbar stenosis, doctors typically start with conservative treatments, such as medications, and reserve surgery if those treatments don’t work or the patient’s quality of life has deteriorated, Dr. Weinberg says.

Fortunately, if surgery is required, surgeons have options today. For many years, the main type of surgery used was a spinal fusion, in which two or more vertebrae are joined together using screws, rods and sometimes a metal plate. This operation requires the surgeon to make a large incision, and most patients need several months for recovery. It also permanently limits the patient’s range of motion in the spine.

“For patients with more difficult cases, spinal fusions are sometimes still the best or even the only option,” Dr. Weinberg says. “But most patients can now be treated successfully with newer, minimally invasive techniques that are much easier for the patient, are motion-preserving, and have a much quicker recovery time.”

Newer Surgical Approaches

Two modern surgical procedures that are commonly used for patients with lumbar spinal stenosis are laminectomy (also called lumbar decompression) and discectomy.

In a laminectomy, the surgeon makes a vertical incision and then removes bone, bone spurs and ligaments that are compressing the nerves inside the spine. The goal of laminectomy is to provide more room for the nerves and thereby relieve or reduce the symptoms caused by nerve compression.

In a discectomy, the surgeon removes the damaged part of a bulging or slipped disk from the spine. The goal of a discectomy is also to reduce compression of the nerves to relieve symptoms.

These procedures typically take anywhere from one to three hours, and most patients can go home from the hospital the same day or the day after surgery. Most patients can return to desk work one to two weeks after surgery; returning to manual labor or sports usually requires two to three months. Physical therapy is a must.

Sometimes a patient might need to have two different types of surgery done at the same time, Dr. Weinberg says. That was the case for Ken Frie, a 72-year-old man who had a lumbar laminectomy on one part of his lower spine, and a spinal fusion on another part of his lower spine. Dr. Weinberg performed both procedures during the same operation.

“The results were fantastic,” Frie said, four months after his surgery. “At this point, I no longer have any pain in my lower back or legs.”


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