Your Back and Leg Pain with Lumbar Spinal Stenosis

There are many reasons for back pain.  Your spine is made up of more than 30 bones, called vertebrae.  Your vertebrae are held together by ligaments, muscles, and “shock absorbing” discs. A problem in any part of your spine can cause back pain. For some, back pain goes away on its own within a few weeks and can get better with rest, medication, or physical therapy. However, for others, there may be a more serious problem. Regardless of the type of back pain you are experiencing, it is important that you see your doctor to properly identify the cause.

Below we describe the symptoms and treatment options for a type of back pain with lumbar spinal stenosis. This content is for educational purposes only and does not replace having a conversation with your doctor.

What is Lumbar Spinal Stenosis?

Lumbar spinal stenosis is a narrowing of the spinal canal that occurs in the lower part of the spine (lumbar region). People who have spinal stenosis are not able to walk for long periods of time. The most common cause of lumbar spinal stenosis is the “wear and tear” that occurs with natural aging effects on the lower spine. It usually develops slowly over time in older patients who have progressive degenerative disease (arthritis). The narrowing of the spinal canal compresses the nerves, which causes pain, numbness, tingling and weakness in the lower back, buttocks and legs; especially after walking and physical activity.

What are the Symptoms of Lumbar Spinal Stenosis?

If you suffer from lumbar spinal stenosis, you may feel various symptoms. You may find these symptoms especially noticeable when you stand or walk:

  • Dull or aching back pain that spreads to your legs
  • Numbness and "pins and needles" in your legs, calves or buttocks
  • Weakness or loss of balance
  • Difficulty walking distances
  • Decreased endurance for physical activities

These symptoms can improve when you bend or lean forward, lie down, or sit.

Often, patients notice relief of their symptoms when they sit down for a short period of time, but when they return to walking, symptoms quickly come back. 

What are the Causes of Lumbar Spinal Stenosis?

In a healthy spine, there is space between the spinal nerves and the borders of the spinal canal. This space allows the spinal sac of nerves and nerves leaving the spine to exit the spinal canal freely and extend to different parts of the body. 

However, with spinal stenosis, the spinal canal space is smaller, making it crowded and difficult for these nerve roots to exit freely through the foramen. As we age, the tissue in our spine that connects bones together (ligaments) may start to thicken and harden from arthritis, discs may start to collapse and bulge (or herniate), and bone spurs, known as osteophytes, may grow on bone in the spine. All of these things narrow the amount of space in the spinal canal, reducing the nerve’s ability to exit and extend to your lower extremities. Therefore, the nerves in the lumbar spine become compressed, causing pain in the lower back, buttocks and legs.
 
Before the diagnosis of stenosis is confirmed, it is important for your doctor to rule out other conditions that may produce similar symptoms. You may be asked to describe the symptoms you are experiencing, how they have changed over time, and what treatments you have tried to treat your symptoms.  A physical examination and additional radiological tests (X-Ray, CAT scan, or MRI) will be needed to confirm that you have spinal stenosis.

                 Healthy Spinal Canal                           Narrowed Spinal Canal           

Lumbar Spinal Stenosis Treatment Options

Non-Surgical Treatment Options

Once your doctor has told you that you have spinal stenosis, treating the condition usually starts with non-surgical, “conservative” treatments. If you experience mild to moderate back and leg symptoms from spinal stenosis, you may feel relief from the following non-surgical options:

  • Patient education
  • Rest or restricted activity
  • Weight loss
  • Medication (non-steroidal anti-inflammatory drugs)
  • Chiropractic care
  • Massage
  • Acupuncture
  • Physical therapy
  • Exercise
  • Injections

Surgical Treatment Options

If your pain cannot be controlled with non-surgical treatment options, a surgical procedure may be recommended. The ultimate goal of surgery is to increase the area of the spinal canal by relieving pressure on the spinal sac and nerves that are trying to extend to the rest of your body. There are a few different surgical treatments that can possibly help relieve your pain from spinal stenosis.

 
Surgical Decompression for Spinal Stenosis

A decompression surgery is a common surgical option to treat spinal stenosis. This procedure involves removing diseased tissue that may affect the spinal nerves. This tissue may include bone, ligament, pieces of disc, or anything that narrows the spinal canal. Once the nerves are decompressed, the nerves are able to function more normally, relieving the symptoms patients experience from spinal stenosis. 

There are many different types of decompression procedures. Your surgeon may suggest a laminectomy, which is a small opening made in the lamina to expose nerves that may experience compression from spinal stenosis. A foraminotomy specifically addresses the opening where the nerve exits the spine, called the foramen, and the goal is to enlarge the area to free up the nerve as it is leaving the spinal canal. Facetectomy is a term surgeons use to describe removing either soft tissue or bone from the facet joint to reduce any pressure on the nerve leaving the spinal canal. These decompression procedures are designed to open up specific areas where your spine may be experiencing spinal stenosis.

 
Surgical Decompression with Spinal Fusion Surgery for Spinal Stenosis

Spinal Fusion surgery involves growing bone in the diseased area of your spine by fusing a spinal segment bone from one vertebra to another vertebra. Spinal fusion is often added after a surgical decompression to help keep the diseased spine segment stable. Often, spinal fusion involves the implantation of metal devices to hold the vertebrae securely in place so the bones can grow and help fuse the vertebrae together. This process may take many months to complete, and often, patient’s activity is restricted for many months to allow for this fusion process to occur. Compared to other surgeries to treat spinal stenosis, spinal fusion usually results in higher blood loss during surgery, more tissue trauma and muscle injury, and takes more time to recover and get back to your normal quality of life.

 
Interspinous Process Distraction without Surgical Decompression (X-STOP®)

An interspinous process distraction device without surgical decompression (X-STOP®) can be inserted in your back to treat spinal stenosis. This device is placed between two bones in the spine called the spinous processes. The X-STOP® device is designed to increase the space between the bones in your back, so the nerves that are trying to exit from your spine will not be pinched. Usually, the X-STOP® device is approved for use in distracting the spinous processes, blocking extension (bending backwards), however without the use of direct surgical decompression techniques for spinal stenosis. Usually the surgeon is not removing the direct offending bone or soft tissue of spinal stenosis during the X-STOP® procedure, therefore, the indirect method is thought to be the mechanism of action for X-STOP®, possibly relieving symptoms of mild to moderate spinal stenosis.

 
The coflex® Solution

The coflex® Interlaminar Stabilization™ device is a titanium implant that goes in the back of your spine to treat moderate to severe spinal stenosis. After your surgeon performs a decompression that can remove bone, facet, ligament and/or disc segments from the narrowed spinal canal, your spine can become unstable. The coflex® device is inserted to help keep your spine stable while maintaining normal height and motion in your spine after surgical decompression. The design and location of the coflex® device in your back helps offset the joints in your spine that are contributing to your back and leg symptoms.

The coflex® Solution focuses on these four important factors:

Protects Your Surgical Decompression - Your surgeon will determine the most effective method for relieving your spinal stenosis symptoms. After your surgeon has performed a decompression, coflex® is implanted to help maintain the decompression.

Stabilization – The coflex® device keeps your spinal column healthy and stable after surgical decompression and maintains foraminal height of your spine where the coflex® was implanted.

Non-Fusion – The coflex® device allows for physiologic motion, including flexion and extension, that allows for the spinal segment to maintain appropriate motion after surgical stabilization. Also, the adjacent levels to the surgical stabilization maintain physiologic motion after the procedure.

Less Invasive – The coflex® procedure is performed through a small, midline incision that allows for a minimally invasive approach for surgical decompression of your spinal stenosis. This less invasive surgery reduces trauma to your back, decreases the amount of blood loss during surgery, and allows for a short hospital stay.

Tens of thousands of coflex® patients worldwide are experiencing pain relief from their spinal stenosis symptoms. The coflex® device could put the step back in your life!  Take a step forward and LEARN MORE about The coflex® Solution.