Lumbar Spinal Stenosis
Lumbar spinal stenosis is a narrowing of the central spinal canal that is a relatively rare condition. It presents with single or multiple radiculopathies. It can be due to arthritic degenerative changes or due to family history. Its prevalence can increase with age, often presenting after age 50. The natural course of lumbar stenosis is one of stable symptoms or improvement with no deterioration based a 4 year prospective trial but exacerbations can be very painful.
The symptoms of lumbar spinal stenosis are thought to be related to mechanical compression of the neural fibers or reduced blood flow to the nerves.
Symptoms can vary widely and can present with little or no back pain. The most common symptoms are:
• Progressive weakness
• Progressive numbness and tingling
• Pseudoclaudication describes buttock, thigh, and leg pain that is worsened with walking or standing and improved with sitting
• “Shopping cart” sign describes improvement in symptoms while pushing a shopping cart in forward flexion.
Other diseases that can mimic spinal disease include:
• Calcium pyrophosphate crystal deposition
• Intraspinal tumors
• Lateral recess stenosis
• Osteoporosis with fracture
• Paget’s disease
The majority of patients with lumbar spinal stenosis may be treated non-surgically.
Often functional rehabilitation with activity modification, postural training, flexion exercises, conditioning using a stationary exercise bike and use of aquatic programs can be helpful. Up to three fluoroscopically-guided epidural steroid injections within a 6 month period can be very effective in relieving symptoms.
Panagos A. Rehabilitation Medicine Quick Reference-Spine (ed. Buschbacher R.M.) New York: Demos Publishing; 2010. p. 150-151.
Rittenberg JD, Ross AE. Functional rehabilitation for degenerative lumbar spinal stenosis. Phys Med Rehabil Clin N Am. 2003 Feb;14(1):111-20.