The lumbar spinal canal consists of five vertebrae, and the nerves originate from the spinal cord within the spinal canal and then leave the spinal canal through the lateral posterior opening of the vertebrae, also known as the intervertebral foramen. Lumbar spinal stenosis is a narrowing of the spinal canal (central canal stenosis) or intervertebral foramina (foraminal stenosis). If the stenosis is solid, it can cause nerve compression and lead to painful symptoms of lumbar spinal stenosis. 1. What causes lumbar spinal stenosis? The most common cause of lumbar spinal stenosis is degenerative osteoarthritis, which, like other joint degeneration in the body, occurs with age. It leads to loss of articular cartilage, formation of bone spurs (bony stumps), loss of disc height and overgrowth of ligamentous structures. Any of these causes can reduce the space for nerve structures directly compressing the nerve tissue causing lumbar spinal stenosis. Lumbar spinal stenosis can also be caused by other causes of spinal stenosis and foraminal narrowing, including: tumors, infections, and various metabolic bone diseases. These causes are very rare. 2. What are the symptoms of lumbar spinal stenosis? Lumbar spinal stenosis can cause: low back pain, weakness, numbness, pain, and sensory disturbances in the lower extremities. Most patients have improved symptoms when sitting or standing or leaning forward, typically with pain in the lower extremities increasing with continued walking and decreasing with rest. Symptoms worsen when standing and reaching backward. This is because bending forward increases the space in the lumbar spinal canal and intervertebral foramen, while extending backward decreases the space in the lumbar spinal canal and intervertebral foramen. Patients are more comfortable sitting, standing and leaning forward and cannot walk long distances. Patients often report that their symptoms improve when they walk with a walker or shopping cart with an anterior tilt. Over time, most patients experience a progressive worsening of their symptoms. This is because degenerative osteoarthritis is a progressive disease that gets worse over time. If the nerve compression caused by lumbar spinal stenosis is not treated, it can cause weakness and loss of lower extremity function. It can also lead to urinary and fecal incontinence and sexual dysfunction. Your doctor can help you determine if your symptoms are caused by lumbar spinal stenosis or other causes. Many other conditions can cause similar symptoms, including: diabetic neuropathy, peripheral vascular disease and vascular claudication. 3. How is lumbar spinal stenosis diagnosed? A physical examination is followed by imaging, starting with an X-ray of the lumbar spine in frontal and lateral hyperflexion and extension, and sometimes an X-ray of the hip joint based on the findings of the physical examination. The final diagnosis of lumbar spinal stenosis is based on MR (magnetic resonance imaging) or CT, which are advanced tests that show the nerves in the lower lumbar spine and whether they are being compressed by lumbar stenosis. compression of the lumbar spinal stenosis. Some patients require special neurological examinations including electromyography or nerve conduction velocity measurements. The results can determine the nerve damage and nerve involvement caused by prolonged lumbar spinal stenosis. 4. How is lumbar spinal stenosis treated? Most lumbar spinal stenosis is treated conservatively (non-surgical treatment). This includes medication, physical therapy, etc. Medications include African steroidal anti-inflammatory and pain medications such as Cilazol, Emmaline, Fotarim, and Fenbid, which help reduce the inflammatory response and decrease pain. Neurotrophic drugs such as Micropod and Epsilon, traditional Chinese herbal medicine such as Genipin, and physiotherapy reduce symptoms by reducing the inflammatory response and edema around the nerve. The above treatment measures can be repeated several times a year. Surgery: Patients with lumbar spinal stenosis may be considered for surgery if the symptoms are not relieved after conservative treatment, if the symptoms worsen, or if there is progressive impairment of urinary and fecal function. The goal of surgical treatment is to remove the nerve-compressing structures of the lumbar spinal stenosis or foraminal stenosis. Such surgery is called lumbar decompression surgery (laminectomy, laminectomy, foraminal enlargement). In some cases, lumbar decompression surgery can be performed alone, and in other cases, lumbar decompression surgery combined with lumbar fusion is required. If the compression of the nerve needs to be removed to a large extent, the vertebrae may become unstable (spinal instability) and if there is abnormal motion between the vertebrae, a lumbar fusion between the abnormally moving vertebrae will be required. Most surgical treatment of lumbar spinal stenosis improves lower extremity symptoms with very satisfactory results; however, some surgical outcomes depend on the severity of nerve compression and the duration of compression; in some cases, the nerve compression is prolonged, the nerve damage is permanent, and surgery does not provide symptomatic relief. The results of surgical treatment for low back pain are not as reliable as those for the lower extremities. 5. How can I prevent lumbar spinal stenosis? Unfortunately, the degenerative changes that cause lumbar spinal stenosis occur with age, so there are no effective measures to prevent lumbar spinal stenosis. If one maintains good sitting and standing posture and actively exercises the muscles of the low back, it may help to slow down the onset of degenerative changes that cause lumbar spinal stenosis, which in turn slows down the onset of lumbar spinal stenosis.