Symptoms of Spinal Stenosis
(please also see section Lumbar Spinal Stenosis)
Spinal stenosis and degenerative spondylolisthesis can cause neurogenic claudication. Neurogenic claudication is a constellation of symptoms. The classic complaints are that the longer the individual stands or walks, the buttocks area becomes “achy and numb” and the legs become “heavy”. The more prolonged the walking, the more intense the symptoms become until they are intolerable. Pain or numbness will radiate further down the legs the longer one stands or walks. Finally, the affected individual has to sit down or bend forward, commonly crouching to relieve the pain. After a period of time, the symptoms resolve and walking can commence again. The cycle then repeats itself.
There is a subset of neurogenic claudication patients who have only lower back pain and no leg symptoms. This particular type of back pain is increased with standing and walking and relieved with bending forward. This is different from patients with degenerative disc disease who get some relief from bending backwards and are aggravated by bending forward. For reasons yet to be understood, the pain from neurogenic claudication is only localized and does not radiate down into the buttock and legs.
If lateral recess stenosis or foraminal stenosis occurs, the pain will be aggravated with the same activities as above but it will occur in only one leg as only one nerve is compressed.
If the patient has accompanying instability, symptoms of instability include lower back pain accompanied with an on-going unstable sensation within the region. Many patients find it difficult to rotate their mid-section. Muscle spasms are also a common occurrence for patients experiencing instability. A painful clunk can occur with motion and an unprepared patient who steps off a too high curb will get an electrical jolt to their back.
Patients with stenosis will unconsciously try to keep their back flat when they walk to keep the canal as open as possible. The only ways to do this are to rotate the pelvis posteriorly and to bend forward. Bending forward while walking wastes a tremendous amount of energy and quickly becomes exhausting. To compensate for this, many patients will keep their knees bent while walking. This maneuver is still very inefficient, but saves more energy than the alternative.
Non-surgical treatments can manage the symptoms of lumbar degenerative spondylolisthesis. Non-steroidal, anti-inflammatory medication along with physical therapy and prescribed exercises typically work well. A core strengthening program and neutral spine program are important. Epidurals are a mainstay of treatment.
There are surgical procedures that can help relieve the pressure on the nerves and therefore the symptoms of degenerative spondylolisthesis with lumbar central stenosis, lateral or foraminal stenosis or instability.
A decompressive laminotomy or laminectomy can be performed to create more space in the spinal canal for the nerves. This is done by removing a portion of the roof of the canal and any spurs that have grown into the canal from the degenerative facets. This is essentially a roto-rooter surgery to make more room for the nerves. Please see section on surgical options for this procedure.
If instability has occurred along with spinal stenosis (example is unstable degenerative spondylolisthesis) spinal fusion stabilization procedure may be required in addition to the decompression surgery. Please see section on surgical options for this procedure.
For more resources on degenerative spondylolisthesis, please contact the Vail, Aspen, Denver and Grand Junction, Colorado area office of spine surgeon and back specialist Dr. Donald Corenman.