Lumbar Spinal Stenosis and Neurogenic Claudication

Abstract

Lumbar spinal stenosis is a degenerative condition that develops and progresses slowly over time. Lumbar spinal stenosis may be local, segmental, or generalized. The majority of lumbar spinal stenosis cases are acquired, degenerative stenosis, resulting from aging of the spine or following surgery or infection. Management of lumbar spinal stenosis is challenging and requires the integration of the history, clinical findings, and results of diagnostic imaging. Magnetic resonance imaging is the most commonly used imaging modality in diagnosing lumbar spinal stenosis. Typical features of spinal stenosis with neurogenic claudication include an increase in symptoms with extension and a decrease with flexion. With lateral recess stenosis or foraminal stenosis, isolated radiculopathy can occur. Spinal stenosis is classified as mild, moderate, and severe, ranging from one third to two thirds of the canal, and grade I to grade III classification of neurogenic intermittent claudication. Management of lumbar spinal stenosis is largely conservative except in cases of severe spinal stenosis and neurogenic claudication with or without paresis and other symptoms. Nonsurgical management of lumbar spinal stenosis includes drugs, physiotherapy, epidural injections, multidisciplinary rehabilitation, and spinal cord stimulation. Minimally invasive techniques include minimally invasive lumbar spinal decompression, interspinous spacers, and endoscopic surgical decompression. The final treatments include open surgery with decompression with or without fusion and spinal cord stimulation. Key words: acquired stenosis, central spinal stenosis, congenital stenosis, decompression with fusion, decompression without fusion, endoscopic spinal decompression, epidural injections, foraminal spinal stenosis, interspinous spacers, lateral spinal stenosis, lumbar spinal stenosis, minimally invasive lumbar decompression, neurogenic claudication, percutaneous adhesiolysis, shopping cart syndrome, spondylolisthesis, vascular claudication