Evaluation and management abstract degenerative lumbar spinal stenosis is caused by mechanical factors andor biochemical alterations within the intervertebral disk that lead to disk space collapse, facet joint hypertrophy, softtissue infolding, and osteophyte formation, which narrows the space. Listing a study does not mean it has been evaluated by the u. Listhesis causes spinal stenosis with neurogenic claudication. Computed tomography myelograms of l23, l34, l45, and l5s1 showing spinal stenosis. Nass clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis provides a definition and explanation of the natural history of degenerative lumbar spinal stenosis, outlines a reasonable evaluation of patients suspected to have degenerative lumbar spinal stenosis and outlines treatment options for adult patients. Lumbar spinal stenosis is a narrowing of the spinal canal, compressing the nerves traveling through the lower back into the legs.
Because of the lack of controlled trials that enrolled only patients with lumbar spinal stenosis, an evidence base for the evaluation of this. Radiologic findings in combination with clinical symptoms are critical in the diagnosis and evaluation of the severity of lumbar spinal stenosis lss as well as the need for surgical treatment. The symptoms of degenerative lumbar stenosis commonly occur in. Patients were eligible if they were at least 40 years. Nonsurgical management consists of nonsteroidal antiinflammatory drugs, physical therapy, and epidural steroid injections. Diagnosis and treatment of degenerative lumbar spinal stenosis. Degenerative lumbar spondylolisthesis sanjay yadla, md. Read about the treatment and prognosis of lumbar spinal stenosis, which is typically caused by degenerative arthritis of the spine. Lumbar spinal stenosis an overview sciencedirect topics. Review of lumbar spinal stenosis with intermittent neurogenic. Lumbar spinal stenosis lss is one of the most common spinal pathologies in the united states. As with other joints in the body, arthritis commonly occurs in the spine as part of the normal aging process and as a result of osteoarthritis. Dynamic radiographs, computerized tomography ct, and magnetic resonance imaging mri each provide different but interrelated pieces of information in the patient with lumbar spinal stenosis.
Degenerative changes of the spine are seen in up to 95% of people by the age of 50. Lumbar spinal stenosis lss is a degenerative spinal condition affecting nearly 50% of patients presenting with lower back pain. Degenerative lumbar spinal stenosis is caused by mechanical factors andor biochemical alterations within the. Lumbar spinal stenosis is a common cause of low back pain and the leading indication for lumbar surgery in the united states for persons over 65 years of age. The present level of understanding of lumbar spinal stenosis is deficient in many areas, including differential diagnosis, treatment, and outcome assessment.
Hughes ap, cammisa fp jr 2012 degenerative lumbar spinal stenosis. The authors discuss a suitable approach to help guide surgical treatment, including decompression, instrumented posterior spinal fusion, anterior spinal fusion, and osteotomy. These changes lead to pain in the legs and back, as well as impaired ambulation and other disabilities. The reported incidence of scoliosis in adulthood has varied from 1. Lumbar ds is a major cause of spinal canal stenosis and is often related to low back and leg pain. Lumbar spinal stenosis archives of physical medicine. Palpation for areas of tenderness over the greater tro.
They can also present with a history of back pain that is worsening, radiculopa. Spivak, jm degenerative lumbar spinal stenosis in jbjs, vol 80, no. The primary forms of degenerative lumbar instability are spondylolisthesis, which is a translation of a single vertebra over another or a more global degenerative scoliosis. Diagnosis and conservative management of degenerative. Symptoms include lower back pain, weakness, numbness, pain, and loss of sensation in the legs. An evidencebased clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis update. Treatment of degenerative lumbar spinal stenosis provides a definition and explanation of the natural history of degenerative lumbar spinal stenosis, outlines a reasonable evaluation of patients suspected to have degenerative lumbar spinal stenosis and outlines treatment options for adult patients with a diagnosis of. Lumbar spinal stenosis exercises are an important part of pain management and recovery for many patients. Management of spinal stenosis is aimed toward symptomatic relief and prevention of neurologic sequelae.
Pressure on the nerve roots is equally common in men and women. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. The most common cause of lumbar spinal stenosis is degenerative arthritis and degenerative disc disease. Oct 30, 2015 the evaluation of four nonoperative treatments for degenerative lumbar spinal stenosis the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Degenerative scoliosis is a prevalent issue among the aging population. Some additional conditions such as foraminal stenosis or. Lumbar spinal stenosis lss is a medical condition in which the spinal canal narrows and compresses the nerves and blood vessels at the level of the lumbar vertebrae. Dynamic radiographs, computerized tomography ct, and magnetic resonance imaging mri each provide different but interrelated pieces of information in the patient with. Lumbar spinal stenosis is a condition that may occur in association with degenerative processes, or as a result of a congenital anomaly or trauma, or in association with pagets disease of the bone. We also discuss the indications for surgery and principles of surgical management. Surgical treatment of degenerative lumbar spinal stenosis. This article aims to provide an overview of the typical presentation and standard management of various thoracolumbar spinal disorders and includes information that is intended to facilitate the investigative and diagnostic. Radiograph demonstrating features of fractional degenerative lumbar scoliosis. Research suggests that when it comes to conditions like lumbar stenosis a fourfold.
Lumbar spinal stenosis has become one of the most disabling pathologies in the elderly population. While it may affect younger patients, due to developmental causes, it is more often a degenerative condition that affects people who are typically age 60 and older. Based on evaluation of studies that contained varying and. Review of lumbar spinal stenosis with intermittent. Diagnosis and treatment of degenerative lumbar spondylolisthesis. Specific history and physical examb nation findings are useful in the diagnosis of lss and should be ascertained routinely in older patients with low back pain. A small number of people are born with back problems that develop into lumbar spinal stenosis. Society nass has defined degenerative lumbar spinal stenosis as a condition in which there is diminished space available for the neural and vascular elements in the lumbar spine secondary to degenerative changes in the spinal canal. Lumbar spinal stenosis lss affects more than 200 000 adults in the united states, resulting in substantial pain and disability. Pdf management of degenerative lumbar spinal stenosis. Cureus radiologic evaluation of lumbar spinal stenosis. Spinal stenosis may also affect the cervical or thoracic region, in which case it is known as cervical spinal stenosis or thoracic spinal stenosis.
Degenerative lumbar spinal stenosis is a major cause of pain and impaired quality of life in the elderly. If spinal malalignment is present, 36inch ap and lateral standing radiographs should be obtained to assess alignment from the femoral heads to the hip pathology differentiating hip pathology from lumbar spine pathology. Degenerative lumbar spinal stenosis dlss is a leading cause of pain, disability, and loss of independence in older adults. Lumbar fusion for spinal instability and degenerative disc. This can lead to loss of the cartilage between the bones at the joints, formation of bone spurs osteophytes, loss of the normal. Spinal stenosis can result in significant morbidity. Degenerative lumbar spinal stenosis diagnostic value of the history and physical examination jeffrey n. Some additional conditions such as foraminal stenosis or degenerative spondylosis with a history.
Degenerative lumbar spinal stenosis lss arises from compression of the cauda equina or exiting nerve roots 1,2, and leads to substantial functional disability 3. Lumbar spinal stenosis symptoms, diagnosis and treatments. Figure 1 in a patient with lumbar spinal stenosis, intrusion of the intervertebral. Simotas, ac nonoperative treatment of lumbar spinal stenosis. It is a chronic disease caused by age related degenerative narrowing stenosis of the spinal canal that can lead to. The surgical management of lumbar spinal stenosis and degenerative spondylolisthesis is critically shaped by whether a spinal arthrodesis instrumented or noninstrumented is performed along with the decompressive procedure. Severe disability and death may result from the association of cervical stenosis with. Lumbar spinal stenosis physical therapy management. Lss is being more commonly diagnosed and may relate to better access to advanced imaging and to an aging population.
Lateral recess stenosis from forward slippage of the inferior articulating process disk herniation contributes to central stenosis caused by. Treatment of degenerative lumbar spinal stenosis american. Physical therapy interventions for degenerative lumbar spinal. This article aims to provide an overview of the typical presentation and standard management of various thoracolumbar spinal disorders and includes information that is intended to facilitate the investigative and diagnostic process. Instructional course lecture differentiating hip pathology from lumbar spine pathology. Degenerative lumbar scoliosis is a lateral deviation of the spine that typically develops after age 50 years. Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication. Listhesis causes spinal stenosis with neurogenic claudication patients have been noted to have deficient coronal portions of the facet and narrow lamina primary symptoms are from. Degenerative and pathological disorders of the thoracolumbar spine may present with symptoms which warrant further evaluation by a neurologist. This distinctive pattern of pain in the back and legs is induced by erect.
Mri evaluation of lumbar disc degenerative disease pokhraj suthar s. Lumbar spinal stenosis lss is most commonly due to degenerative changes in older individuals. An evidencebased clinical guideline for the diagnosis and. Instructional course lecture differentiating hip pathology.
Managing degenerative lumbar spinal stenosis rheumatology. Conservative measures such as pharmacologic therapy and physical therapy provide temporary relief but remain an important adjunct in the overall treatment algorithm preceding surgical decompression. Surgical treatment of degenerative lumbar spinal stenosis a. According to the fda, an ide allows the investigational device to be used in a clinical study in order to collect safety and effectiveness data required to support a premarket approval pma application or a premarket. Dec 01, 20 lumbar spinal stenosis lss is a condition in which narrowing of the central spinal canal, lateral recess, or foramen leads to compression of the neural and vascular structures, resulting in back and leg pain, disability particularly decreased walking capacity, and substantially diminished healthrelated quality of life. If nonsurgical management is unsuccessful and neurologic decline persists or progresses, surgical treatment, most commonly laminectomy, is indicated. Review article degenerative lumbar spinal stenosis. Diagnosis and treatment of degenerative lumbar spinal stenosis 2011 revised. Aug 01, 2004 spinal stenosis is a narrowing of the vertebral canal that compresses spinal nerves and may cause leg pain and difficulty walking.
Spinal stenosis is a narrowing of the vertebral canal that compresses spinal nerves and may cause leg pain and difficulty walking. In this article, we describe the diagnostic evaluation of degenerative lumbar spinal stenosis and approaches to nonsurgical treatment. To provide evidencebased recommendations to address key clinical questions surrounding the diagnosis and treatment of degenerative lumbar spinal stenosis. Degenerative lumbar spinal stenosis and its imposters. Controversy remains over the role of surgical intervention in patients with this disease. Iii, decompression and lumbar curve instrumented fusion. To reflect contemporary treatment concepts for symptomatic degenerative lumbar spinal stenosis as reflected in the highest quality clinical literature available on this subject as of july 2010. Mar 26, 2020 management of spinal stenosis is aimed toward symptomatic relief and prevention of neurologic sequelae. The diagnosis of symptomatic lss in an older patient with back pain 4 has implications for treatment, because symptoms caused by nerve root. Lumbar spinal stenosis treatment strategies and indications for surgery ortho. Degenerative lumbar spinal stenosis lss arises from compression of the cauda equina or exiting.
The degenerative process typically results in a stiff but stable lumbar spine. It is the most common reason for spinal surgery in patients over 65 years. Degenerative lumbar scoliosis is a 3dimensional deformity of the spine with a coronal deviation of greater than 10. Degenerative lumbar spondylolisthesis sanjay yadla, mdsanjay yadla, md october 10, 2008 department of neurological surgery.