The lumbar spine is made of five vertebrae. Its two primary purposes are to allow us to move the back, and to protect the spinal cord and nerves that travel through it. As we age, it is normal for the disks between the bones to wear out, or degenerate. This is called degenerative disk disease, or spondylosis.

When a disk wears out, it behaves like a tire without enough air. It not only shrinks down in height, but bulges at the sides. In some people, this bulging can combine with other arthritic changes of the spine to narrow the spinal canal, where the nerves travel. It can get to the point where it is so tight that there is pressure being placed on the nerves. This narrowing is called lumbar spinal stenosis.

If enough pressure is placed on the nerves, they can start to malfunction. This is a condition known as neurogenic claudication. Spinal stenosis shows up as difficulty with walking and pain, numbness and/or weakness in the legs with standing or walking that improves with sitting. Many patients have the gradual onset of symptoms over months or years. Often, it is family or friends who notice that the patient is walking bent forward or that you cannot walk for any length of time and need to sit down often.

One treatment option is to “wait and see”, sometimes using physical therapy, massage, acupuncture, or chiropractic to help control symptoms. Sometimes oral steroids are used to decrease nerve swelling and inflammation. Other medications may include a “nerve stabilizer” such as Neurontin (gabapentin), or a non-steroidal anti-inflammatory (NSAID). Another option is what is called an epidural steroid injection. In this procedure, a Pain Management doctor uses an x-ray machine for guidance to inject cortisone/steroids around the nerves. The goal is to decrease inflammation around the nerve and improve leg symptoms.

Finally, the surgical option is to make more room in the canal by removing the posterior bone arch of the lumbar vertebrae. This is called a laminectomy and involves an incision on the low back so that we can enter the spinal canal to make more space and relieve the pressure on the nerves. This has about a 90% chance of relieving leg pain, but it must be understood that it may not help back pain at all. It can usually stop the leg from getting weaker, but does not always result in the recovery of full strength. The effects on numbness are less predictable.