Lumbar spinal stenosis

The main sign is intermittent neurogenic claudication: pain, fatigue, or heaviness in the legs when walking, which worsens when standing and improves when sitting or leaning forward. These symptoms are caused by compression of the nerves when the spine is extended and their release when it is flexed.

Other symptoms may accompany this pain:

• tingling or numbness (paresthesia),
• cramps,
• weakness in the legs.

Lower back pain may be present, but it is not always related to stenosis. These signs may develop slowly and gradually limit walking distance or daily activities.

There are two main forms:

• Congenital form: the canal is narrow from birth. Symptoms appear earlier, often between the ages of 30 and 40.
• Acquired form: this is the most common form and results from degenerative processes associated with aging. The discs wear out, the ligaments thicken, and the joints become deformed, reducing the space in the spinal canal.

Other causes can also lead to stenosis: herniated discs, osteophytes (bone spurs), trauma or fracture, or degenerative spondylolisthesis (slip of one vertebra over another).

Aging is the main factor, often associated with a history of low back pain. A genetic predisposition or anatomical abnormality of the spine (such as scoliosis) can contribute to the development or worsening of lumbar spinal stenosis

The diagnosis is initially clinical: the doctor asks the patient about their pain and difficulty walking, then looks for neurological signs (decreased reflexes, loss of sensitivity, muscle weakness, but the clinical examination is usually normal). MRI is the gold standard test: it shows the degree of narrowing and helps identify the cause. A CT scan may be performed when MRI is contraindicated

Treatment depends on the severity of the symptoms and their impact on quality of life.

Non-surgical treatment (first line)

• Painkillers and anti-inflammatory drugs.
• Corticosteroid injections (variable effectiveness).
• Physical therapy: exercises to strengthen muscles and improve posture.

Surgical treatment

If pain persists or severely limits walking, decompression surgery may be recommended to release the nerves. Studies show that this option often provides more effective long-term improvement.

Biportal endoscopy: a modern technique

This method uses two small millimeter incisions: one for the camera and the other for the instruments.
It allows for precise decompression while limiting muscle damage.
Its main advantages are:

• reduced post-operative pain,
• faster recovery,
• often no implants required,
• low overall risk of complications (less than 2%).

The disease progresses slowly: in many patients, symptoms remain moderate. In more severe cases, walking becomes difficult.
The most serious, but rare, complication is cauda equina syndrome, which causes loss of urinary or anal control, numbness in the genital area, and paralysis of the legs.
This is a surgical emergency. It is rare for the condition to reach this stage; most patients undergo surgery for less severe but debilitating symptoms

It is difficult to completely prevent lumbar stenosis, but it is possible to slow down the progression of symptoms and their impact on quality of life. Recommended measures include:

• maintaining good physical fitness,
• strengthening the back and abdominal muscles,
• adopting good posture,
• avoiding repeated heavy lifting

It is advisable to consult a doctor when leg pain occurs repeatedly when walking and is relieved when sitting or leaning forward. The onset of tingling, numbness, or muscle weakness should also be cause for concern, especially if these symptoms worsen.
Emergency consultation is required in the event of:

• Loss of bladder or bowel control
• Numbness in the genital area
• Sudden difficulty walkin

Hôpital de La Tour offers multidisciplinary care: spine surgeons (orthopedists or neurosurgeons), rheumatologists, rehabilitation specialists, and physical therapists, as well as a pain clinic, work together to develop a personalized treatment plan.
The hospital is skilled in minimally invasive techniques such as biportal endoscopy, under the direction of Dr. Antonio Faundez, who also trains other surgeons in this method.
Appropriate rehabilitation is then offered to help each patient regain mobility and independence