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Lumbar Spinal Stenosis (LSS): Causes and Treatments

Reviewed by Dr. Nileshkumar Patel, M.D., M.B.A.

Lumbar spinal stenosis (LSS) is a condition that causes the spinal canal to narrow. The term “stenosis” comes from the Greek word meaning “choking.” As the name suggests, when the spaces in the spine narrow, the nerves in the back are compressed, as if they’re being choked. The condition develops slowly as we age and our spines degenerate, leading to pain and discomfort in the lower back and legs.

What are the symptoms of lumbar spinal stenosis?

The first symptoms of LSS tend to be bouts of pain in the lower back. The pain or discomfort will generally worsen over a period of months or years and can extend down into the legs. It is common for people with LSS to find relief by bending or leaning forward, as this motion helps to open up the space in the spine and relieve the pressure on the nerves. Because standing up and walking increases the pressure on the nerves, activities that require standing or walking – doing the dishes, for example, or shopping – are difficult for the LSS patient.

Patients may not only describe their discomfort as pain; LSS symptoms include numbness, tingling, or a cramping sensation. The pain can be axial (meaning it is restricted to the lower back) or radicular (going down the legs).

What are the treatment options for lumbar spinal stenosis?

There are a variety of different options for treating LSS, ranging from conservative, non-surgical options to invasive surgical procedures.

Nonsurgical treatments include use of a cane, physical therapy, and pain medications. Doctors may also prescribe epidural steroid injections. Unfortunately, there is no clear evidence that medication or injections provide long-term relief. 

If symptoms persist for six months or longer with conservative care, back surgery may be considered. Surgical options include:

  • Laminectomy, which involves removing a portion of the vertebrae and is considered a major spine operation
  • Spinal fusion, which is a procedure that joins two or more vertebrae, often using hardware including screws and plates
  • Discectomy, which is the surgical removal of a portion of the herniated disc that may be causing LSS

All these surgical options involve permanent, irreversible changes to the spine, and often there is hospitalization and risks associated with general anesthesia.

What is the Vertiflex™ Procedure†?

A minimally invasive alternative to irreversible back surgeries, the Vertiflex Procedure uses a small implant to help relieve pressure on the nerves in the spine caused by LSS. The small, titanium implant is placed between two vertebrae to help open the space. The placement of the implant is usually done in an outpatient setting. The Vertiflex Procedure has been shown to provide long-lasting relief from pain, numbness, and weakness in the legs, and to reduce dependence on opioid medication.1,2

What are the key points about lumbar spinal stenosis?

  • LSS is a common condition that can cause pain and numbness in the lower back and legs
  • There are a variety of treatment options, ranging from prescription medication to invasive back surgery 
  • The Vertiflex Procedure is an alternate solution that can help reduce dependence on pain medication and provide lasting relief 
  • The Vertiflex Procedure is a minimally invasive, reversible, outpatient procedure
  • The Vertiflex Procedure preserves your spinal architecture, so you still have options for further treatments in the future
  • If you are experiencing symptoms associated with LSS, it is important to visit a doctor to get a diagnosis and discuss your treatment options

Download the doctor discussion guide to help you during your consultation

Wondering if The Vertiflex Procedure may be right for you?

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References:

†Superion™ Indirect Decompression System 

1. Nunley PD, Deer TR, Benyamin RM, Staats PS, Block JE. Interspinous process decompression is associated with a reduction in opioid analgesia in patients with lumbar spinal stenosis. J Pain Res. 2018;11:2943-2948. 2. Nunley PD, Patel VV, Orndorff DG, Lavelle WF, Block JE, Geisler FH. Five-year durability of stand-alone interspinous process decompression for lumbar spinal stenosis. Clin Interv Aging. 2017;12:1409-1417. N=88

Indications for Use: The Boston Scientific Spinal Cord Stimulator Systems are indicated as an aid in the management of chronic intractable pain of the trunk and/or limbs including unilateral or bilateral pain associated with the following: failed back surgery syndrome, Complex Regional Pain Syndrome (CRPS) Types I and II, intractable low back pain and leg pain, Diabetic Peripheral Neuropathy of the lower extremities, radicular pain syndrome, radiculopathies resulting in pain secondary to failed back syndrome or herniated disc, epidural fibrosis, degenerative disc disease (herniated disc pain refractory to conservative and surgical interventions), arachnoiditis, multiple back surgeries. The Boston Scientific Spectra WaveWriter™, WaveWriter Alpha™ and WaveWriter Alpha™ Prime SCS Systems are also indicated as an aid in the management of chronic intractable unilateral or bilateral low back and leg pain without prior back surgery.

Contraindications. The Spinal Cord Stimulator systems are not for patients who are unable to operate the system, have failed trial stimulation by failing to receive effective pain relief, are poor surgical candidates, or are pregnant.

MR Conditional symbol

Boston Scientific’s ImageReady™ MRI Technology makes safe MRI head scans possible. Patients implanted with the Precision Spectra™ or Spectra WaveWriter™ Spinal Cord Stimulator Systems with ImageReady™ MRI Technology are "MR Conditional" only when exposed to the MRI environment under the specific conditions defined in the applicable ImageReady™ MRI Head Only Guidelines for Precision Spectra™ or Spectra WaveWriter™ Spinal Cord Stimulator Systems.

MR Conditional symbolBoston Scientific’s ImageReady™ MRI Full Body Technology makes safe MRI scans possible. The Precision Montage™ MRI, WaveWriter Alpha™ and WaveWriter Alpha™ Prime SCS Systems with ImageReady™ MRI Full Body Technology are “MR Conditional” only when exposed to the MRI environment under the specific conditions defined in the applicable ImageReady™ MRI Full Body Guidelines for Precision Montage™ MRI or WaveWriter Alpha™ and WaveWriter Alpha™ Prime Spinal Cord Stimulator Systems.

Warnings. Patients implanted with Boston Scientific Spinal Cord Stimulator Systems without ImageReady™ MRI Technology should not be exposed to Magnetic Resonance Imaging (MRI). Exposure to MRI may result in dislodgement of the stimulator or leads, heating of the stimulator, severe damage to the stimulator electronics and an uncomfortable or jolting sensation. As a Spinal Cord Stimulation patient, you should not have diathermy as either a treatment for a medical condition or as part of a surgical procedure. Strong electromagnetic fields, such as power generators or theft detection systems, can potentially turn the stimulator off, or cause uncomfortable jolting stimulation. The system should not be charged while sleeping. The Spinal Cord Stimulator system may interfere with the operation of implanted sensing stimulators such as pacemakers or implanted cardiac defibrillators. Advise your physician that you have a Spinal Cord Stimulator before going through with other implantable device therapies so that medical decisions can be made and appropriate safety measures taken. Patients using therapy that generates paresthesia should not operate motorized vehicles such as automobiles or potentially dangerous machinery and equipment with the stimulation on. Stimulation must be turned off first in such cases. For therapy that does not generate paresthesia (i.e. subperception therapy) it is less likely that sudden stimulation changes resulting in distraction could occur while having stimulation on when operating moving vehicles, machinery, and equipment. Your doctor may be able to provide additional information on the Boston Scientific Spinal Cord Stimulator systems.  For complete indications for use, contraindications, warnings, precautions, and side effects, call 866.360.4747 or visit Pain.com. Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.

Indications for Use: The Superion™ Indirect Decompression System (IDS) is indicated to treat skeletally mature patients suffering from pain, numbness, and/or cramping in the legs (neurogenic intermittent claudication) secondary to a diagnosis of moderate degenerative lumbar spinal stenosis, with or without Grade 1 spondylolisthesis, having radiographic evidence of thickened ligamentum flavum, narrowed lateral recess, and/or central canal or foraminal narrowing. The Superion™ Interspinous Spacer is indicated for those patients with impaired physical function who experience relief in flexion from symptoms of leg/buttock/groin pain, with or without back pain, who have undergone at least 6 months of non-operative treatment. The Superion Interspinous Spacer may be implanted at one or two adjacent lumbar levels in patients in whom treatment is indicated at no more than two levels, from L1 to L5. Contraindications, warnings, precautions, side effects. The Superion Indirect Decompression System (IDS) is contraindicated for patients who: have spinal anatomy that prevent implantation of the device or cause the device to be unstable in situ (i.e., degenerative spondylolisthesis greater than grade 1), Cauda equina syndrome, or prior decompression or fusion at the index level, scoliosis or spinous process fractures, osteoporosis, infection, allergy or reaction to any metal or implant or a high Body Mass Index. Avoid strenuous activity for 6 weeks after surgery, contact your physician if there is fluid leaking from your incision, if you have pain, swelling or numbness in your legs or buttocks or if you fall. Refer to the Instructions for Use provided on www.vertiflex.com for additional Indications for Use, contraindications information and potential adverse effects, warnings, and precautions prior to using this product. Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.

Indications for Use: The Boston Scientific Radiofrequency Generators, associated Radiofrequency Lesion Probes and RF Cannula are indicated for use in procedures to create radiofrequency lesions for the treatment of pain or for lesioning nerve tissue for functional neurosurgical procedures. The Boston Scientific RF Injection Electrodes are used for percutaneous nerve blocks with local anesthetic solution for radiofrequency lesioning of peripheral nerve tissue only. The Boston Scientific LCED and Stereotactic TCD Electrodes are indicated for use in radiofrequency (RF) heat lesioning of nervous tissue including the Central Nervous System.

Warnings: The Boston Scientific RF devices may cause interference with active devices such as neurostimulators, cardiac pacemakers, and defibrillators. Interference may affect the action of these active devices or may damage them. For appropriate guidance, consult the instructions for use for these active devices. Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.

§The physician locator tool identifies pain management specialists in your area who have met certain qualifying criteria and are experienced with one or more of Boston Scientific pain management therapies. All treatment options should be discussed thoroughly with a pain management specialist.