Natural Course and Diagnosis of Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations

Abstract Lumbar spinal stenosis (LSS) is defined as a degenerative disorder showing a narrowing of the spinal canal. The diagnosis is straightforward in cases with typical neurogenic claudication symptoms and unequivocal imaging findings. However, not all patients present with typical symptoms and there is obviously no correlation between the severity of stenosis and clinical complaint. Radiologic diagnosis of LSS is widely discussed in the literature. The best diagnostic test for diagnosis of LSS is MR imaging. However, canal diameter measurements have not gained much consensus from radiologists while qualitative measures, such as CSF space obliteration, have achieved greater consensus. Instability can best be defined by standing lateral radiograms and flexion-extension radiograms. For cases showing typical neurogenic claudication symptoms and unequivocal imaging findings the diagnosis is straightforward. However, not all patients present with typical symptoms and there is obviously no correlation between the severity of stenosis (CT and MRI) and clinical complaint. In fact, recent MRI studies have shown that mild to moderate stenosis can also be found in asymptomatic individuals. Routine electrophysiological tests such as lower extremity electromyography, nerve conduction studies, F wave, and H reflex are not helpful in the diagnosis and outcome prediction of LSS. The electrophysiological recordings are complementary to the neurological examination and can provide confirmatory information in less obvious clinical complaints. However, in the absence of reliable evidence, imaging studies should be considered as a first line diagnostic test in the diagnosis of degenerative LSS.