What is stenosis of the lower back?
What is spinal stenosis of the lower back?
The nerves leave the spinal cord beneath the thoracic vertebrae and run through the lower back like electric wires. The nerve canal is a triangular tube, which contains the nerve tract. This nerve tract is filled with nerves and cerebrospinal fluid, sometimes called “liquor”. The spinal column is a flexible body part that helps us stay physically active: We twist, we turn, we bend over, we bike, we swim, we golf.
Therefore it is understandable that the nerves need some room for movement. This is necessary so the nerves are not overextended or pulled in any unnatural directions. The nerves swim in and are surrounded by the spinal fluid, which protects them and enables them to move freely. This is especially important when walking, which is a repetitive movement that puts daily strain on the spine. Unfortunately, the flexibility of the spine decreases throughout life due to age-related degeneration. With this natural degenerative process the nerve canal tends to become narrower. Also the innate radius of the nerve canal differs from person to person.
Arthrosis of the vertebral joints can cause the growth of bone spurs that then put pressure on the nerve canal. Also, due to a loss of height of the intervertebral disc, the tight band at the back of the nerve canal can start to fold in on itself and limit the width of the nerve canal. At first, you won't notice anything, because the spinal fluid can still move around the constrictions. This in itself is not yet a problem, as long as the fluid can still flow through the canal and protect the nerves from harm. However, if the narrowing of the nerve canal increases so much that the nerves are no longer protected by the spinal fluid, we call this stenosis. And if the stenosis is severe enough that there is no more spinal fluid surrounding the nerves, typical symptoms can occur.
Stenosis symptoms: What complaints indicate a stenosis in the lower back?
If you lead an inactive life and only walk short distances or if you use a bike to get around, a stenosis will not impair your daily life much. But if you like to go on longer walks or exercise, you will notice a decrease in stamina and your walking distance will become increasingly shorter.
When you have stenosis, walking increases the pressure on the nerves causing swelling in the affected area of the spine. The blood supply to the nerves is impaired and because of the swelling they need more space than is accessible. In this case the nerves can no longer fulfill their purpose of signaling to the muscles of the legs.
The result is that the legs feel heavy and do not want to work properly anymore. After walking a short distance you will have to stop and bend over for a little while, to decrease the pressure in the spine. Leaning on something like a shopping cart while walking can relieve the symptoms. But after a while it will get worse again, those assistive tools will not suffice anymore and the distance you are able to walk will decrease. If the symptoms of the stenosis are severe enough to impair your daily life or the pain is no longer bearable, it makes sense to seek medical help. An MRI is the right diagnostic tool to see if you are suffering from stenosis and to decide whether a microscopic surgery is a valid treatment option.
Why does stenosis present like intermittent claudication?
Intermittent claudication, also called vascular claudication, shortens the walking distance of the affected patient as well. In Dutch we call it “etalageziekte” which roughly translated means “window shopping disease”. The name indicates how short the walking distance of the affected patient can become, forcing them to stop at every other step to recover, like one would stop to look at store windows along the way. There are two possible causes: nerve canal stenosis and blood vessel stenosis. Since both conditions are common in the elderly, it is important to find out which of the two is the cause of the complaint in your case. Stenosis of the back can be influenced by your posture. For example rounding the back and bending over can provide temporary relief because it gives the nerve canal more room.
Is the shopping cart your new best friend?
However with stenosis of the blood vessels in the groin or the legs, also called vascular claudication, a change in posture does not help to improve the symptoms. So if you cannot walk long distances but have no symptoms when taking your bike, this is indicative of stenosis. You have the same symptoms either way (walking/biking/bending over etc.)? Then it makes sense to have your blood vessels checked, this could mean that you have intermittent claudication rather than stenosis of the back.
How can stenosis be resolved?
With stenosis in the lower back the nerve canal narrows thereby affecting the nerves, they can no longer move freely and perform their function sufficiently. If we look at a healthy spinal canal in an MRI it usually looks like a triangle, but with stenosis it gets pinched and starts resembling the letter T instead. Viewed from the side, the nerves no longer lie loosely on the right side, surrounded by white fluid. Below the stenosis the nerves are tightly compressed and pulled tight above it. In the microscopic surgery that we perform under general anesthesia, we can remove the tissue that presses on the nerve. With small drills, we grind away the bone in the affected area and remove the thickened ligament with a forceps. We only do this in the specific areas that cause the symptoms. This is done to minimize scarring. After the surgery we can already see the nerve moving freely again with every heartbeat. This is clear evidence that the fluid flows freely around the nerves and the nerves can perform their function in the body sufficiently again.
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Frequently Asked Questions about
spinal stenosis sy
What are the early symptoms of spinal stenosis?
In the beginning, you may notice mild lower back discomfort or tiredness in your legs when walking. The pain usually improves when you sit down or lean forward. Many people don’t recognise these signs straight away.
Why do I feel better when sitting down?
Sitting or bending forward temporarily widens the spinal canal and relieves pressure on the nerves. This explains why many people can walk further when leaning on a walking aid or shopping trolley.
Why do my legs feel heavy or weak when I walk?
As the spinal canal narrows, the nerves that control your legs get compressed. This can disrupt signal flow and lead to a feeling of heaviness, weakness, or a dragging sensation in the legs—especially after walking short distances.
Why does my walking distance keep getting shorter?
This is a typical sign of worsening spinal stenosis. As nerves get more irritated with movement, they become swollen, reducing walking endurance. Sitting usually brings relief.
Is back pain always present with stenosis?
Surprisingly, not always. Some people experience more leg-related symptoms, while others may have no back pain at all. It varies from person to person.
Can posture affect my symptoms?
Absolutely. Bending slightly forward can relieve symptoms, while standing upright or leaning back may make them worse. Proper posture and movement techniques can help manage discomfort.
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