Lumbar Stenosis

Lumbar spine stenosis is most common in middle age and the elderly.Symptoms include pain in the lower back and lower extremities, limited movement, numbness and tingling , weakness. Most cases of lumbar stenosis is caused by degenerative and arthritic changes in the intervertebral discs, ligaments and the facet joints surrounding the lumbar canal. Men are affected more so than women. CT scans with or without intrathecal contrast is one diagnostic way to find stenosis. However,MRI is better at viewing soft tissue, the cauda equina, spinal cord, ligaments , epidural fat, subarachnoid space and intervertebral discs. Decompressive lumbar laminectomy is the surgical treatment for lumbar stenosis.This is a serious surgery with risks. Although around ninety five percent of patients find some level of relief and consider this to outweigh the risk. Lumbar bracing, bed rest, physical therapy and pain management are the non surgical treatments.
Figures 4A and 4B . (Left) Unenhanced T₁-weighted axial magnetic resonance scan at a lumbar level showing severe stenosis. The combination of ligament and facet joint hypertrophy concentrically reduces the diameter of the lumbar canal. The significant reduction in the relative amount of epidural fat and subarachnoid cerebral spinal fluid signal is further evidence of the degree of canal stenosis. (Right) Unenhanced T₁-weighted sagittal magnetic resonance scan of the lumbosacral spine showing severe canal stenosis at the L4-5 level, produced by a combination of disc herniation, spondyloarthritis and posterior element hypertrophy. Compare this stenosis with the moderate degree of stenosis observed at levels above. Mild spondylolisthesis is also evident at L5-S1. Magnetic Resonance Imaging