Lumbar spinal stenosis

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. Spinal stenosis may also affect the cervical or thoracic region, in which case it is known as cervical spinal stenosis or thoracic spinal stenosis. Lumbar spinal stenosis can cause pain in the low back or buttocks, abnormal sensations, and the absence of sensation (numbness) in the legs, thighs, feet, or buttocks, or loss of bladder and bowel control. L5 S1 Spondylolisthesis Grade II with forward slipping of L5 on S1 <50%Lumbar spine showing advanced ankylosing spondylitis which can lead to spinal stenosis 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. Spinal stenosis may also affect the cervical or thoracic region, in which case it is known as cervical spinal stenosis or thoracic spinal stenosis. Lumbar spinal stenosis can cause pain in the low back or buttocks, abnormal sensations, and the absence of sensation (numbness) in the legs, thighs, feet, or buttocks, or loss of bladder and bowel control. The precise cause of LSS is unclear. Narrowing of spinal structures in the spinal cord such as the central canal, the lateral recesses, or the intervertebral foramen (the opening where a spinal nerve root passes) must be present, but are not sufficient to cause LSS alone. Many people who undergo MRI imaging are found to have such changes but have no symptoms. These changes are commonly seen in people who suffer from spinal degeneration that occurs with aging (e.g., spinal disc herniation). LSS may also be caused by osteophytes, osteoporosis, a tumor, trauma, or various skeletal dysplasias, such as with pseudoachondroplasia and achondroplasia. Medical professionals may clinically diagnose lumbar spinal stenosis using a combination of a thorough medical history, physical examination, and imaging (CT or MRI). EMG may be helpful if the diagnosis is unclear. Useful clues that support a diagnosis of LSS are age; radiating leg pain that worsens with prolonged standing or walking (neurogenic claudication) and is relieved by sitting, lying down, or bending forward at the waist; and a wide stance when walking. Other helpful clues may include objective weakness or decreased sensation in the legs, decreased reflexes in the legs, and balance difficulties, all of which are strongly associated with LSS. Most people with LSS qualify for initial conservative non-operative treatment. Nonsurgical treatments include medications, physiotherapy, and injection procedures. Decompressive spinal surgery may modestly improve outcomes but carries greater risk than conservative treatment. Overall, there is limited supporting evidence to determine the most effective surgical or nonsurgical treatment for people with symptomatic LSS. Evidence to support the use of acupuncture is also limited. Lumbar spinal stenosis is a common condition and causes substantial morbidity and disability. It is the most common reason people over the age of 65 pursue spinal surgery. The condition affects over 200,000 people in the United States. Understanding the meaning of signs and symptoms of lumbar stenosis requires an understanding of what the syndrome is, and the prevalence of the condition. A recent review of lumbar stenosis in the Journal of the American Medical Association's 'Rational Clinical Examination Series' emphasized that the syndrome can be considered when lower extremity pain occurs in combination with back pain. The syndrome occurs in 12% of older community-dwelling men and up to 21% of those in retirement communities. Because the leg symptoms in lumbar spinal stenosis (LSS) are similar to those found with vascular claudication, the term pseudoclaudication is often used for symptoms of LSS. These symptoms include pain, weakness, and tingling of the legs, which may radiate down the legs to the feet. Additional symptoms in the legs may be fatigue, heaviness, weakness, a sensation of tingling, pricking, or numbness, and leg cramps, as well as bladder symptoms. Symptoms are most commonly bilateral and symmetrical, but they may be unilateral; leg pain is usually more troubling than back pain. Pseudoclaudication, now generally referred to as neurogenic claudication, typically worsens with standing or walking, and improves with sitting, and is often related to posture and lumbar extension. Lying on the side is often more comfortable than lying flat, since it permits greater lumbar flexion. Vascular claudication can resemble spinal stenosis, and some individuals experience unilateral or bilateral symptoms radiating down the legs rather than true claudication. The first symptoms of stenosis include bouts of low back pain. After a few months or years, this may progress to claudication. The pain may be radicular, following the classic neurologic pathways. This occurs as the spinal nerves or spinal cord become increasingly trapped in a smaller space within the canal. Determining whether pain in the elderly is caused by lack of blood supply or stenosis is difficult; testing can usually differentiate between them, but patients can have both vascular disease in the legs and spinal stenosis. Among people with lower-extremity pain in combination with back pain, lumbar stenosis as the cause is two times more likely in those older than 70 years of age while in those younger than 60 years it is less than half as likely. The character of the pain is also useful for diagnosis. When the discomfort does not occur while seated, the likelihood of lumbar spinal stenosis increases considerably, around 7.4 times. Other features increasing the likelihood of lumbar stenosis are improvement in symptoms on bending forward (6.4 times), pain that occurs in both buttocks or legs (6.3 times), and the presence of neurogenic claudication (3.7 times). On the other hand, the absence of neurogenic claudication makes lumbar stenosis much less likely as the explanation for the pain.