Back pain that causes weakness, or numbness in the legs, calves, or buttocks, with pain radiating into one or both thighs and legs, is commonly caused by lumbar spinal stenosis, a condition in which the spinal canal becomes narrow and compresses the nerves that run through the lower back into the legs. The increased pressure on the nerves causes inflammation that results in back pain.
Bending forward, sitting, or lying down may cause the pain to decrease. Walking short distances may cause it increase.
Spinal stenosis may also create sciatica. The sciatic nerve runs from the lower back down the back of each leg. Sciatica usually affects only one side of the lower body. When the sciatic nerve is inflamed, symptoms may include pain in the buttocks or leg that is worse when sitting; burning or tingling in the leg, weakness, numbness, or difficulty moving the leg or foot, and shooting pain that makes standing difficult. The pain may also reach the foot or toes.
Conditions that may lead to lumbar spinal stenosis include osteoarthritis and scoliosis (curvature of the spine). Commonly, lumbar spinal stenosis develops over time, with symptoms typically affecting people age 60 and over.
In some cases, nonsurgical measures, including anti-inflammatory medications to reduce swelling and pain, weight loss and physical therapy, may provide relief. Epidural injections of cortisone may also help relieve swelling, but this treatment generally provides temporary relief and is not recommended for repeated therapy. When these measures do not end or control pain, your physician may recommend evaluation by a neurosurgeon.
At Baptist, neurosurgeons treat patients surgically to relieve back and leg pain. To help determine if you are a candidate for back surgery, a surgeon will perform a physical examination and review your medical history. Diagnostic tests that may be used include:
In general, surgery to relief back pain from lumbar spinal stenosis will involve one or more of the following procedures:
In this procedure, part of the vertebrae is removed to create more space for the nerves. A neurosurgeon may perform a laminectomy with or without fusing vertebrae.
In this procedure, the surgeon removes a damaged disc from the spinal column and fills the resulting gap with a bone graft. This graft fuses to existing bone in the spinal column to help stabilize the spine. The incision for this procedure is made on the patient’s back. Screws and rods may be used to provide additional support.
This procedure is similar to the posterior lumbar interbody fusion, with the exception of where the incision is made. In the anterior procedure, the incision is made on the patient’s abdomen.
In this procedure, the surgeon widens the area of the spine where a nerve root leaves the spinal canal by cutting or shaving away part of the bone. This takes pressure off the nerve.
During this procedure, the surgeon removes part of the lamina, which is the back part of each vertebra that forms the back wall of the spinal canal.
grafting bone onto the spine to create a solid union between two or more vertebrae. Screws and rods may be used to provide additional spinal support.
A minimally invasive procedure involving small incisions in the abdomen, through which a graft is placed into the disc space.
In certain cases, surgeons may use minimally invasive techniques for these procedures. One such procedure is the Minimally Invasive Microlumbar Discectomy. In the procedure, the surgeon makes a small (1 inch to 1 1/2 inch) incision in the center of the lower part of the back, then, using operating glasses (loupes) or a microscope to visualize the nerve, removes part of the bone or damaged disc. This relieves pressure on the nerve and reduces inflammation. Almost all of the joints, ligaments and muscles are left intact, so this procedure does not change the mechanical structure of the patient's lumbar spine. In some cases, this may be performed on an outpatient basis.
Recovery will depend on the procedure you require. Your doctor will usually prescribe pain medication and help determine when you can resume normal activities, including work, driving and exercising. It is common to feel some discomfort as you slowly increase activity, but increased pain may be a warning that you are doing too much too soon.
If you would like to be treated at Baptist for back pain, the first step is being seen by one of our surgeons. Your physician can make arrangements for this appointment. All surgeons on staff at Baptist are board certified, and many have sub-specialty training within their field.
See Neurosurgeons at Baptist.
Source: American Association of Neurological Surgeons, U.S. National Library of Medicine
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