What Are The Symptoms of Severe Spinal Stenosis of The L4-L5 Segment and How to Treat It?

The spine consists of 33 vertebrae stacked on top of each other. Depending on their location, the vertebrae provide different degrees of load-bearing and flexibility for the spine. 

The L4-L5 spinal segment consists of the two lowest vertebrae in the lumbar spine. It provides motion in many directions and supports the upper torso. 

L4 and L5 undergo heavy impact with day-to-day motions and are highly flexible. This makes them particularly susceptible to injury and chronic conditions, including spinal stenosis. 

In this article, we’ll explore severe spinal stenosis of the L4-L5 spinal segment and the symptoms that most commonly accompany this condition. 

L4-L5

Table of Contents

A Brief Overview of Spinal Stenosis

Spinal stenosis affects roughly 250,000 to 500,000 people in the United States, making it one of today’s most prevalent spinal conditions. It occurs when the open spaces in the spinal canal become narrower, potentially leading to spinal nerve impingement. Spinal stenosis may also cause spinal cord compression. 

What Are The Most Common Spine Segments That Spinal Stenosis Damages?

Spinal stenosis most commonly occurs in the lumbar spine, followed by the cervical spine. Although the thoracic spine may also be affected by spinal stenosis, it’s far less likely. 

The lumbar spine includes the L1, L2, L3, L4, and L5 vertebrae. When spinal stenosis affects this area, it’s known as lumbar spinal stenosis. 

Lumbar spinal stenosis is most often caused by age-related spinal degeneration. The natural aging process can cause several changes in the spine that trigger stenosis, including:

  • Wear and tear on the facet joints of the spine (osteoarthritis)
  • Bone spurs
  • Intervertebral disc damage (bulging or herniated discs)
  • Thickened spinal ligaments

Severe Spinal Stenosis L4-L5 Symptoms

Severe spinal stenosis L4-L4 symptoms may include:

  • Debilitating pain in the lower back and leg
  • Sexual dysfunction
  • Constant pain, numbness, and/or tingling in the legs while standing
  • Difficulty or inability to perform upright activities
  • Bladder or bowel incontinence
  • Severe weakness in both legs
  • Numbness in the genital and inner thigh area
  • Foot drop

Sexual Dysfunction with Lumbar Spinal Stenosis

Lumbar spinal stenosis can cause sexual dysfunction or pain during intercourse. According to a 2022 study published in Sexual Medicine Reviews, more than half of patients with spinal stenosis and degenerative spine disease experience pain with sexual activity. 

Spinal stenosis can cause sexual dysfunction if it causes the compression of the nerves responsible for sexual function. This typically only occurs in severe cases. 

If you experience reduced sexual function or pain during intercourse with lumbar spinal stenosis, schedule an evaluation with a physician immediately. Prompt care is essential to prevent permanent nerve damage. 

What is Foot Drop with Spinal Stenosis?

“Foot drop” is a symptom resulting from weakness in the anterior tibialis muscle. It’s most often caused by L4-L5 radiculopathy, which can be triggered by spinal stenosis. 

With foot drop, it’s difficult or impossible to point the ankle and toes upward. This causes the foot to slap onto the ground while walking, with the leg dragging in front of the foot. Foot drop can also throw off your balance. 

Foot drop can be debilitating and may keep you from staying active with lumbar spinal stenosis. Thankfully, not all cases of foot drop are permanent, and many can be resolved with prompt treatment. Physical therapy, bracing, splits, and nerve stimulation are common non-surgical therapies for this symptom of L4-L5 spinal stenosis. 

L4-L5 Nerve Root Compression Symptoms

Symptoms of L4-L5 nerve root compression include:

  • Pins and needles sensation in the legs and feet
  • Chronic lower back pain
  • Numbness, tingling, and weakness that travel from the lower back to the legs and feet
  • Achiness in the back
  • Back stiffness
  • Cramping in the calves after short periods of walking or at night

Spinal nerve roots are the beginning portion of the spinal nerve as it exits the spinal cord. They’re responsible for supplying various parts of the body with sensation and triggering motion. 

The L4-L5 nerve roots are the lowest nerve roots of the lumbar spine. The cauda equina is typically located between spinal levels L1 and L5. So, nerve root compression at the L4-L5 levels may affect the cauda equina and pose the risk of cauda equina syndrome. 

Calf Cramping with Lumbar Spinal Stenosis

Lumbar spinal stenosis can cause frequent calf cramping, usually while walking or at night. Even slight motions can cause cramping in individuals with severe spinal stenosis.

This cramping is thought to be caused by nerve root compression. In other words, when spinal stenosis compresses the spinal cord, it activates the nerves that supply the muscles, making them engage and cramp. Leg cramping with spinal stenosis may indicate nerve damage and requires prompt medical care. 

L4-L5 Pain Symptoms

L4-L5 pain symptoms may include:

  • Sharp, burning, or stabbing pain that originates in the lower back and travels into the legs
  • Dull, achy lower back pain
  • Lower back stiffness
  • A tingling or pins-and-needles sensation that travels from the lower back into the legs
  • Painful muscle spasms in the lower back

These pain symptoms can accompany various spinal conditions affecting the L4-L5 segment, including spinal stenosis, spondylolisthesis, and herniated disc. L4-L5 pain can also worsen with certain activities, including:

  • Bending forward, especially repeatedly
  • Twisting the spine, including for certain sports like golfing 
  • Lifting heavy objects
  • High-impact activities, like jumping, running, and contact sports

To prevent L4-L5 pain symptoms, you can adjust your routine to limit certain positions, activities, and habits, including:

  • Household chores that involve repetitive bending, like vacuuming and doing laundry
  • Gardening and shoveling, which involve repetitive forward bending and lifting
  • Running, jumping, jogging, weightlifting, golf, and tennis – try low-impact alternatives like walking and swimming
  • Yoga poses that involve deep spinal twists, back arches, or squats
  • Lifting heavy objects – if you need to pick something up, make sure to bend at your knees and keep your back straight

Sitting for long periods or prolonged bed rest can also worsen L4-L5 pain symptoms. While short periods of rest can calm acute back pain, a lack of mobility can cause muscle weakness and tension. Leading a sedentary lifestyle diminishes blood flow throughout the body, hindering the natural recovery process. 

To avoid being sedentary without straining the L4-L5 segment, you can try taking short walks throughout the day, taking swimming or water aerobics classes, and working with a physical therapist to learn safe stretches and strengthening exercises. If you have a desk job, periodically using a standing desk can help you avoid spinal strain from sitting for hours on end.

What Are The Symptoms of L4-L5 Damage?

Some patients experience no symptoms from lumbar spinal stenosis. However, if this condition causes nerve impingement, it can provoke symptoms of sciatica. 

Sciatica is a diagnosis used to characterize pain in the sciatic nerve. The sciatic nerve stretches from the lower back to the buttocks and down the back sides of the legs. The main symptoms of sciatica include:

  • Sharp pain that begins in the lower back and moves down the leg
  • Weakness in the leg with motion
  • Numbness in the leg, foot, and/or toes
  • Tingling and/or pins-and-needles sensation along the sciatic nerve

Damage in the L4-L5 spinal segment may also lead to cauda equina syndrome, in severe cases. 

What is Cauda Equina Syndrome?

The cauda equina is a collection of nerve roots located in the lumbar spine. It includes nerve roots spanning from L2 to Co1 in the coccygeal spine. Cauda equina syndrome develops if multiple nerve roots included in the cauda equina are irritated or damaged. 

Warning signs of cauda equina syndrome include:

  • Bladder and/or bowel dysfunction
  • Saddle anesthesia, which occurs when the patient loses sensation in the buttocks, perineum, and inner thighs
  • Weakness or paralysis of a nerve root
  • Sciatica
  • Sexual dysfunction

Diagnosis of L4-L5 Canal Stenosis

Left untreated, cauda equina syndrome can cause permanent nerve damage. So, if you’ve been diagnosed with spinal stenosis and experience the symptoms listed above, seek out emergency medical attention. 

L4-L5 canal stenosis is diagnosed with a medical history, comprehensive physical exam, and imaging tests to determine the condition’s severity. 

  • Medical history

When you visit your healthcare provider for lumbar canal stenosis symptoms, your provider will likely start by gathering a complete medical history. This can help identify factors that may be contributing to your symptoms, like underlying medical conditions or past surgeries. Your physician will also ask various questions about your symptoms (like how severe they are, how often you experience them, and if they occur with specific movements) to better understand your condition. 

  • Physical exam

After discussing your medical history and symptoms, your doctor will complete a comprehensive physical exam. During this exam, they’ll check for signs of spinal stenosis in certain positions, including numbness, weakness, and atypical reflexes. 

  • Imaging tests

If your exam points to possible lumbar spinal stenosis, your physician may order imaging tests to view the spinal canal and determine how advanced the condition is. These tests can help your doctor make a definitive diagnosis and recommend the best possible treatment plan for your needs. Imaging tests that may be used to diagnose L4-L5 canal stenosis include:

MRI (magnetic resonance imaging) uses magnetic fields and radio waves to generate highly detailed images of the inside of the body. Unlike x-ray imaging, MRIs can show soft tissues in great detail, including the spinal cord, nerves, discs, and ligaments. This can make MRIs extremely helpful in diagnosing and evaluating L4-L5 canal stenosis.  

X-ray imaging uses ionizing radiation to create images of the inside of the body. X-rays display bones, organs, and other internal structures. They may help your physician identify bone structures and changes, like bone spurs, that contribute to L4-L5 canal stenosis. 

CT scans (computed tomography scans) use a computerized x-ray imaging process that develops cross-sectional images of the body. CT scans are more detailed than traditional x-rays and may help your provider accurately identify abnormalities in the spine. 

What is The Best Treatment for Spinal Stenosis at L4 and L5?

In most cases, physicians first recommend a conventional treatment plan for lumbar spinal stenosis at L4 and L5. With early intervention, many patients can recover from this spinal condition without having to undergo surgery. 

The most common conventional treatments for spinal stenosis at L4 and L5 include:

  • Physical therapy, which may involve strengthening and flexibility exercises, stabilization, joint mobilization, heat or ice therapy, and massage
  • Lifestyle and activity modifications, such as quitting smoking and starting a low-impact exercise routine
  • Over-the-counter or prescription medications, such as NSAIDs, analgesics, anti-seizure drugs, and antidepressants
  • Chiropractic care, which focuses on improving spinal alignment with manual adjustments
  • Acupuncture, which may help stimulate the body’s natural healing process

With that said, conventional treatment options can’t correct the narrowing of the spinal canal. Surgery is required to gain more space in the spinal canal and may be required if:

  • Conventional treatment options fail to provide relief after six to 12 months
  • The patient is at risk of permanent neurological damage
  • The patient’s symptoms are severely disabling

What Does Surgery For L4-L5 Spinal Stenosis Involve?

Surgery for spinal stenosis at the L4-L5 segment most commonly includes laminectomy. This procedure involves removing some or all of the lamina to create more open space in the spinal canal and alleviate nerve compression. 

The lamina is a small piece of bone that forms part of the vertebral arch. It covers the back of the spinal canal. By removing some or all of this bony spinal component, your spinal surgery can effectively resolve symptoms of spinal stenosis. 

Unfortunately, a laminectomy can pose the risk of spinal instability. To negate this risk, many surgeons have paired the procedure with spinal fusion. 

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Is An L4-L5 Fusion Major Surgery?

L4-L5 spinal fusion involves positioning bone graft material in between the L4 and L5 vertebrae. This causes the vertebrae to permanently fuse over several months. After this procedure, patients have no motion at the fused segment. 

Simply put, yes: L4-L5 fusion is a major surgery that must be performed by a neurosurgeon or an orthopedic surgeon. It’s a complex procedure, during which the patient must be under anesthesia. Additionally, the recovery process for spinal fusion can span a full year. 

Rehabilitation After L4-L5 Lumbar Stenosis Surgery

Rehabilitation after L4-L5 lumbar stenosis surgery involves activity modification, physical therapy, and low-impact exercise. Lifestyle adjustments, like eating a nutritious diet and limiting alcohol consumption, can further support recovery. 

  • Activity modifications after L4-L5 lumbar stenosis surgery will fluctuate as you heal and recover. In the earliest healing stages, your movements will be relatively limited, and you’ll be advised to avoid stretching, twisting, or bending the spine. However, it’s also important to avoid prolonged bed rest, as it can strain the spine and contribute to weak muscles. 
  • Physical therapy is a crucial component of rehabilitation after spinal surgery. Your PT will help you regain strength and mobility through targeted exercise, stretches, and complementary treatments. You may also work with your PT to correct imbalanced movement patterns that could slow your recovery. 
  • Low-impact exercise (while adhering to your doctor’s exercise restrictions) promotes circulation, muscle strength, and flexibility during stenosis surgery rehabilitation. Options typically include walking, swimming, and water aerobics, although your PT can make personalized recommendations based on your condition. 

Modern Alternative to L4-L5 Stenosis Surgery Fusion – Premia Spine TOPS System

Considering the risks and downsides of spinal fusion, many patients with L4-L5 spinal stenosis seek out ways to avoid it. Some patients may successfully achieve this feat by committing to a conventional treatment plan, including all recommended lifestyle adjustments. 

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Unfortunately, not all patients will experience relief from conventional treatments, even after several months or even years. In these cases, patients may consider spinal fusion alternatives, specifically including non-fusion implants. Modern medical technology has allowed for advanced implants that stabilize the spine after lumbar decompression without compromising the motion of the spine – Premia Spine TOPS System.

Reach out to a reputable spine specialist in your area to learn more about the latest fusion alternatives for L4-L5 spinal stenosis.