What Is the Best Treatment for Spinal Stenosis at L4 and L5?
Spinal stenosis most often develops in the lumbar spine, including at the L4-L5 spinal level. Though common, this spinal condition can be debilitating, especially when it’s left untreated. Understanding the symptoms of L4-L5 spinal stenosis, as well as the available treatments, can help you preserve your spinal health and avoid serious complications.
Keep reading to explore the best treatment for spinal stenosis at L4 and L5, including alternatives to the conventional spinal fusion procedure.
L4-L5 Spinal Stenosis Overview
L4-L5 spinal stenosis is the narrowing of the spinal canal at the L4-L5 level, which is the lowest segment of the lumbar spine. As the spinal canal narrows, the space around the spinal cord and nerves narrows, increasing the risk of nerve impingement.
L4-L5 Spinal Stenosis Symptoms
If L4-L5 spinal stenosis leads to nerve impingement, it can trigger various symptoms, including:
- Lower back pain that may travel into the buttocks and legs
- Tingling, numbness, and weakness in the lower extremities
- “Foot drop”, the term used for weakness in the foot that causes it to slap onto the ground when you walk
- Cramping in the leg muscles, especially with physical activity
L4-L5 Spinal Stenosis Causes
Many different factors can cause L4-L5 spinal stenosis, including:
- Spinal degeneration: The gradual breakdown of the spine with age is the most common cause of spinal stenosis. Wear and tear builds up over time, leading to thickened spinal ligaments, bone spurs, and damaged spinal discs. These changes take up space in the spinal canal and may impinge on nearby nerves.
- Osteoarthritis is known as “wear and tear” arthritis and can affect the facet joints of the spine. It can develop with age and lead to bone spurs, increasing the risk of spinal stenosis.
- Herniated discs: This spinal disc injury is relatively common, especially in people aged 35 to 50. Whether from a traumatic injury or spinal degeneration, a disc is considered herniated if the jelly-like disc interior protrudes through a crack in the disc exterior. The herniated disc can take up space in the spinal canal, leading to spinal stenosis.
- Genetics: Some people are simply born with a narrower spinal canal than usual. Though relatively rare, this is known as congenital spinal stenosis and can cause back pain earlier in life – usually between ages 30 and 50.
The Best Treatments for L4-L5 Spinal Stenosis
When it’s addressed early, L4-L5 spinal stenosis can usually be treated with non-surgical remedies including physical therapy, lifestyle modifications, and pain medications. When possible, these therapies are preferable to surgery because they involve fewer risks and less downtime.
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Bonnie explains why TOPS surgery was the right decision for her
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Scott speaks about going to surgery
Physical therapy for lumbar spinal stenosis involves safely strengthening the core and back muscles, which support the spine. Your PT can also recommend stretches to calm muscle tension that could be exacerbating your pain. Some PTs also offer complementary therapies, like electromagnetic stimulation, to aid your recovery process.
Lifestyle modifications can address underlying factors that contribute to spinal stenosis pain, including exercise, nutrition, posture, and even smoking. Implementing a low-impact exercise routine, eating healthily, improving your posture, and quitting smoking can prime your body for a successful recovery.
Pain medications can bring down inflammation and help you manage pain while your body heals. While medications are by no means a quick fix or permanent solution to L4-L5 spinal stenosis, they can be used in conjunction with other treatments to support your recovery.
At What Point Does L4-L5 Spinal Stenosis Require Surgery?
L4-L5 spinal stenosis may require surgery when it reaches the point of severe pain and disability, with no improvement after several months of conservative treatment.
If your L4-L5 spinal stenosis becomes severe, you and your doctor will discuss whether surgery is the right choice for you. Thankfully, patients today have access to more advanced surgical methods than ever, including minimally-invasive spine surgery. This is in contrast to past generations, who were often confined to surgical decompression with spinal fusion for spinal stenosis.
Additionally, L4-L5 spinal stenosis may require surgery if you experience symptoms of cauda equina syndrome, which puts you at risk of permanent nerve damage. These symptoms include:
- Changes in bladder or bowel function
- Numbness in the saddle region (the inner thighs, buttocks, and genitals)
- Sexual dysfunction
- Leg weakness
- Diminished reflexes in the lower extremities
Generally, cauda equina syndrome requires emergency spinal decompression surgery to alleviate pressure on the affected nerves before it causes paralysis.
Premia Spine TOPS System Benefits Over Spinal Fusion
Compared to spinal fusion, the Premia Spine TOPS System provides many benefits, including preserved spinal motion, less downtime, and balanced forces across the spine. These benefits are part of the reason why the FDA awarded the TOPS System a superior-to-fusion claim.
Spinal fusion stabilizes the spine after spinal decompression surgery for spinal stenosis. Unfortunately, it also permanently fuses two (or more) vertebrae in your spine, reducing your range of motion. It can also take up to a year to recover from fusion, with the risk of adjacent segment degeneration going forward.
How exactly does the TOPS System prevent these downsides? As a dynamic spinal implant, it replaces the tissues removed during spinal decompression surgery. This creates a controlled range of motion in the spine, allowing it to safely move in any direction.
Since the TOPS System doesn’t require bone healing, it also allows for less time in the hospital and a shorter recovery than fusion. Most patients can start moving around the day after surgery, with far fewer restrictions on their activities.
By preserving motion at the affected spinal level, the TOPS System balances the forces across your spine when you move. This protects the adjacent spinal levels from accelerated degeneration, which tends to occur with fusion.
The TOPS System is designed for spondylolisthesis and spinal stenosis at the L4-L5, L2-L3, or L3-L4 levels. If you’re interested in this spinal fusion alternative to resolve severe L4-L5 spinal stenosis pain, find a participating physician in your area today.
