腰椎管狭窄症

Lumbar spinal canal stenosis is a narrowing of the main tunnel in the lower back that carries the nerves to the legs, so those nerves get squeezed when standing or walking. This often causes leg pain, heaviness, or cramping with walking that eases when sitting or bending forward.​

1) What is this condition?

  • The central canal in the lower spine becomes smaller due to disc bulges, bone spurs, thickened joints/ligaments, or small slips of the vertebrae.​

  • The squeezed nerves cause “neurogenic claudication”: aching, tingling, or weakness in the buttocks and legs that worsens with standing or walking and improves with sitting or leaning forward.​

2) How serious is it?

  • Most cases are slowly progressive and mainly affect walking distance and quality of life, not life expectancy.​

  • Severe untreated stenosis can lead to marked walking limitation and, rarely, loss of bowel/bladder control or significant leg weakness requiring urgent care.​

3) Non‑surgical treatments

  • Activity modification and posture changes: avoiding prolonged standing or backward bending; using slight forward flexion (shopping cart posture) to relieve symptoms.​

  • Physical therapy: flexion‑biased exercises, core and hip strengthening, stretching, gait and balance training, and sometimes a lumbosacral corset or walking aids.​

  • Medicines: anti‑inflammatory drugs, pain relievers, and sometimes nerve‑pain medicines.​

  • Injections: epidural steroid injections or nerve‑root blocks to reduce inflammation and pain and improve walking tolerance.​

  • Integrative options: heat, massage, acupuncture, TENS, and weight loss to reduce load on the spine.​

4) What type of surgery may be necessary?

  • Lumbar laminectomy (decompression): removing part of the bony “roof” and thickened tissue to open the canal and free the nerves.​

  • Decompression with fusion: laminectomy plus screws/rods and bone graft when there is significant instability or deformity (for example, spondylolisthesis).​

5) Goals of surgery vs non‑surgical care

  • Non‑surgical goals:

    • Control pain, improve walking and standing tolerance, and maintain independence without the risks of major surgery.​

  • Surgery goals:

    • Directly relieve pressure on the nerve roots, improve neurogenic claudication and leg pain, and increase walking distance and function.​

6) How surgery will fix the problem

  • Laminectomy and related decompressions remove bone spurs, overgrown joints, disc bulges, and thickened ligaments from the canal, enlarging the space around the nerves.​

  • If fusion is done, hardware holds the vertebrae still while bone graft heals across them, restoring stability and preventing the levels from collapsing or slipping again.​

7) Risks of surgery (general and specific)

  • General: infection, bleeding, blood clots, anesthesia and heart/lung complications, more likely in older adults.​

  • Spine‑specific:

    • Dural tear (spinal fluid leak) occurring in about 10% in some laminectomy series.​

    • Nerve injury with new or worse leg weakness, numbness, or bladder/bowel problems (uncommon but serious).​

    • With fusion: reduced motion at fused levels and risk of adjacent‑segment degeneration over time.​

8) Chances this surgery will work

  • Studies of lumbar laminectomy show significant improvements in back pain, claudication, leg pain, weakness, and sensory loss for most patients.​

  • In one series, reoperation after first‑time laminectomy was about 14.4% over 3.4 years; lifetime risk of later needing a fusion was about 8%.​

9) Possible complications from surgery

  • Short‑term: wound infection, hematoma, spinal fluid leak, urinary issues, or cardiopulmonary complications.​

  • Long‑term: recurrent stenosis, ongoing back pain (linked to higher re‑operation risk), adjacent‑segment problems after fusion, and need for additional surgeries in a minority of patients.​

10) Typical recovery from the condition (without surgery)

  • Symptoms often wax and wane; many people manage for years with therapy, exercise, and occasional injections, though walking distance may slowly decline.​

  • A subset develops marked walking limitation and disability and may ultimately choose surgery for better quality of life.​

11) Typical recovery after surgery

  • Hospital phase: early walking, pain control, and basic mobility training; bending, lifting, and twisting are limited initially.​

  • First months: physical therapy to rebuild strength, posture, and endurance; many experience improved leg symptoms within weeks, with continued gains over several months.​

  • If fusion was done, bone healing and full activity resumption may take 6–12 months, with a longer recovery course than decompression alone.​

12) How long in the hospital

  • Simple laminectomy is often 1–3 days in hospital if recovery is uncomplicated.​

  • Decompression with multi‑level fusion or patients with significant medical issues may require longer stays.​

13) Long‑term outlook

  • Lumbar stenosis is chronic and degenerative, but many patients achieve lasting relief of leg pain and improved walking after decompression.​

  • Some continue to have or develop back pain and may need ongoing conservative care or further surgery, particularly if there is progressive degeneration.​

14) Need for outpatient follow‑up

  • Non‑surgical: periodic review to adjust exercise, medications, and injections, and to reassess if walking tolerance or neurologic signs worsen.​

  • Post‑surgery: scheduled visits to monitor wound and neurologic recovery, plus imaging (especially if fusion was done) to track alignment, hardware, and bone healing.​

  • Long‑term: ongoing emphasis on weight control, core strengthening, posture, and bone and cardiovascular health, with early reassessment for new or recurrent leg symptoms or bladder/bowel changes.