Lumbar Spinal Stenosis

Narrowing of the spinal canal in the lumbar spine → compression of nerve roots

• Leads to neurogenic claudication

Causes

• Degenerative arthritis (most common in older adults)
• Intervertebral disc herniation
• Spondylolisthesis
• Ligamentum flavum hypertrophy
• Congenital canal narrowing (rare)

Clinical Features

Neurogenic Claudication (classic finding)

• Leg pain/weakness with standing or walking
• Pain improves with sitting or spinal flexion (e.g., leaning forward, uphill walking)
• Worsens with extension (e.g., walking downhill or standing upright)
• Bilateral or unilateral leg symptoms

Other findings:

• Low back pain
• Possible sensory loss, paresthesias, or mild motor weakness
• No specific dermatomal distribution (vs. radiculopathy)
• Rare: bowel/bladder incontinence (suggests severe compression or cauda equina syndrome)

Diagnosis

• MRI of the lumbar spine = imaging of choice
  • Shows canal narrowing and nerve root compression
• CT myelogram: alternative if MRI contraindicated
• X-rays: may show degenerative changes or spondylolisthesis (low sensitivity)

Management

Conservative (first-line):

• Physical therapy
• NSAIDs or acetaminophen
• Weight loss
• Epidural corticosteroid injections (for symptom relief)

Surgical:

• Laminectomy (decompression surgery) if:
  • Refractory to medical management
  • Severe symptoms affecting quality of life
  • Progressive neurologic deficits