November 27, 2019
Lower back pain can be caused by a variety of factors, but in 22% of patients the culprit is lumbar spinal stenosis, or LSS, said Dr. Brett Bentley, assistant professor of sports medicine at The University of Alabama College of Community Health Sciences. He said the compression of the nerves extending from the spinal cord, called the nerve roots, or the cord itself can cause serious issues that can be debilitating in extreme circumstances.
Bentley also provides patient care in the Bill deShazo Sports Medicine Center at University Medical Center. He spoke to UA’s Osher Lifelong Learning Institute (OLLI) Mini-Medical School participants on October 29. CCHS operates UMC.
While most people will experience temporary back pain in their lives, it is important to seek medical advice when the pain is persistent or accompanied by symptoms like fever, unexplained weight loss, progressive lower limb weakness or sensory loss, a history of cancer, incontinence or sudden excruciating pain. These could be signs of other “mimickers” of LSS such as peripheral vascular disease, a ruptured aortic aneurism, a malignant tumor or several other health issues.
A diagnosis of LSS is often made via clinical history alone, but can be further supported by certain exam findings (for example, the extension test, where symptoms are provoked by standing with one’s back in extension for 30-60 seconds), and finally corroborated by imaging – usually an MRI.
Often in geriatric patients the cause of the spinal stenosis is degenerative changes caused by the bulging of the discs between vertebrae, or arthritic complications like bony spurs. Disc protrusion, extrusion or sequestration can all cause nerve pain in the lumbar region by either compressing the cord or lateral branches or irritating them with fluids.
“When the disc has herniated, the fluid that is inside the disc is outside the sack allowing it to inflame the nerves,” Bentley said. “Essentially, the jelly has left the doughnut.”
Often, a disc can bulge, and it won’t cause any symptoms. Patients are is able to go on with their daily lives without any knowledge of the issue, Bentley said. It is when the nerves are being constricted that a patient will experience pain, numbness and in extreme cases incontinence.
Most cases of LSS will resolve in six months’ time, and Bentley recommends physical therapy first and foremost. There is also structured walking programs, acetaminophen, short-term NSAIDs or steroids or an epidural steroid injection. The last resort when the LSS is affecting quality of life in an unbearable way is spinal surgery.
The Mini Medical School Program, a partnership of the College and UA’s OLLI Program, features lectures provided by College faculty physicians about current topics, issues and advances in medicine and health. OLLI is a member-led program catering to those aged 50 and older.