Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal in the lumbar region, in which the surrounding osseous and soft tissue structures lead to nerve compression [1] [2]. This condition is either congenital [3] or secondary to a degenerative process, trauma, infection, or surgery [4]. LSS commonly affects the aging population and has a slight predilection for males [1].

The clinical presentation, which is insidious, initially consists of backache but eventually progresses to include worsening pain, fatigue, weakness, and numbness of the leg(s) [1]. Specifically, patients describe symptoms such as tingling, burning, cramping, fatigue, and stiffness of the lower extremities. Moreover, the leg pain is most often bilateral and radiates distally, particularly with exercise [1].

As evident in the majority of cases, neurogenic intermittent claudication is the most predominant sign attributed to LSS [4] [5]. This manifestation is produced and worsened by walking or standing but alleviated with sitting or lying down on the side [1] [4]. Squatting and bicycle riding may also provide relief since flexion of the trunk leads to widening of the lumbar canal [1]. As the disease advances, the patient is likely to adopt a stooped posture [1].

LSS in the younger population [6] may cause radicular symptoms consisting of unilateral neurogenic claudication due to stenosis of the foraminal or lateral recess canal [4]. These patients experience severe leg pain that is worsened with lumbar extension [7].

Complications

Excruciating leg pain, paresthesia, and difficulty with ambulation are all likely sequelae in patients with LSS. Additionally, other possible complications include neurogenic bladder and/or abnormal bowel function [1] [8] and nocturnal leg cramps [9].

Physical exam

On visual inspection, the patient may have a stooped posture. Furthermore, examination of the lower back reveals limited extension [6]. Additionally, a neurological assessment may show absent or reduced ankle reflexes as well as sensory deficits [4].

• Disability

  Primary outcomes were pain intensity, physical function or disability status, quality of life, and recovery. [ncbi.nlm.nih.gov]

• Localized Pain

  This nerve compression usually results in local pain in the back and radiating pain in the buttocks, legs and feet. If you have been diagnosed with lumbar spinal stenosis, you understand the limitations lower back pain places on your life. [laserspineinstitute.com]

  If the ligamentum flavum buckles to the point that it impinges a spinal nerve, a patient may experience the following symptoms of spinal stenosis: Weakness Numbness Localized pain Radiating pain (depending on the location of the spinal stenosis, the pain [physio-pedia.com]

  […] limb areas may cause local pain. [ebm-guidelines.com]

• Arm Pain

  Symptoms of cervical stenosis may include neck pain, limb weakness, arm pain and numbness, loss of balance and loss of dexterity. The main symptoms of lumbar and lumbosacral stenosis are leg pain or numbness and lower back pain. [brighamhealthhub.org]

• Choking

  When the spinal nerves in the lower back are choked, lumbar spinal stenosis occurs and most often leads to leg pain and other symptoms, as described in more detail below. [spine-health.com]

  Central Stenosis : Occurs when a nerve in the lower back is compressed or choked, possibly resulting in compression of the cauda equina nerve roots. The cauda equina nerve roots are located at the bottom of the spinal cord. [floridamedicalclinic.com]

  It is a disease in which damaged joints and disks and thickened ligaments put pressure on the nerves as if choking them. Symptoms of lumbar spinal canal stenosis include leg pain and numbness in addition to intermittent claudication. [otsuka.co.jp]

• Fecal Incontinence

  Of great interest is the occurrence of phenomena such as intermittent penile erections and fecal incontinence on walking in patients with compromise of the lower lumbar spinal canal. [ncbi.nlm.nih.gov]

  Imaging may be considered earlier if there is a history of malignancy, concern for infection, a fracture, symptoms of true myelopathy (progressive or severe neurologic deficits), in the setting of cauda equina syndrome (urinary retention, fecal incontinence [appliedradiology.com]

  The ten activities include eating/feeding, disposing of stool (presence of absence of fecal incontinence), urination (presence or absence of urinary incontinence), using the toilet, dressing, grooming (shaving, brushing teeth and hair, etc.), transferring [bmrat.org]

• Ulcer

  Too many NSAIDs can cause ulcers and other stomach problems and, especially among older people, may increase the chance of heart attacks and strokes. They might also interact with other medicines. [webmd.com]

  NSAIDs are contraindicated in patients with peptic ulcer disease, congestive heart failure, and renal disease due to the potential for serious adverse effects. When there is still inadequate pain control, opioid therapy may be initiated. [practicalpainmanagement.com]

  They can lead to gastritis or stomach ulcers. If you develop acid reflux or stomach pains while taking an anti-inflammatory, be sure to talk with your doctor. Steroid injections. Cortisone is a powerful anti-inflammatory drug. [orthoinfo.aaos.org]

• Muscle Weakness

  SYMPTOMS OF Lumbar Spinal Stenosis Symptoms of lumbar spinal stenosis can include: Lower back pain Leg pain Thigh or buttock pain Calf cramping or tightness Numbness in the legs or feet Muscle weakness Pain while walking or standing [mispinerelief.com]

  The doctor tests your reflexes and evaluates you for muscle weakness, loss of feeling, and signs of neurological injury. [spinesurgery.com]

  Lumbar spinal stenosis symptoms and treatment While the cause of your lumbar spinal stenosis may vary the symptoms slightly, the main symptoms associated with spinal stenosis are as follows: Lower back pain Muscle weakness Numbness Radiating pain in the [laserspineinstitute.com]

  During the exam, the doctor evaluates loss of extremity reflexes, muscle weakness, loss of sensation, or other signs of a neurological problem. Diagnostic tests. [coloradospineinstitute.com]

  This may cause pain that radiates into the shoulder, as well as muscle weakness and numbness that travels down the arm and into the hand. [orthoinfo.aaos.org]

• Unable to Walk

  Patients are frequently unable to walk for long distances and often state that their symptoms are improved when bending forward while walking with the support of a walker or shopping cart. The symptoms commonly worsen with time. [medicinenet.com]

• Abnormal Gait

  Early symptoms are mostly abnormal sensations in the hands, abnormal gait – particularly in the dark –, and deficiencies in the fine motor skills of the hands. Disturbances in writing mostly occur at advanced stages. [doi.org]

Patients presenting with the above symptoms should be evaluated by their personal history, clinical picture, physical exam findings, and confirmatory studies. It is important to note that the severity of the clinical presentation does not usually correspond to the degree of stenosis [1].

Imaging

The American College of Physicians (ACP) recommends against routine imaging for low back pain unless there are risk factors for infection, malignancy, or other diseases [10] [11]. However, the traditional workup has included spinal radiography as the initial test. In patients with LSS, this modality is likely to reveal abnormalities such as degenerative changes in the disc or vertebrae, or other disease processes [1].

A spinal computed tomographic (CT) scan provides visualization of the canal and allows for accurate measurements of its diameter [1]. It may demonstrate narrowed canal with impingement by surrounding structures resulting in a "cloverleaf" or the pathognomonic "trefoil" appearance. To improve sensitivity, intrathecal contrast can be used but this is associated with risks.

Magnetic resonance imaging (MRI), the preferred study for diagnosis of LSS, is useful in the assessment of the spinal cord and associated soft tissue structures such as the cauda equina, epidural fat, intervertebral discs, etc. [1]. Additionally, this test helps rule out differential diagnoses. Specifically, LSS has characteristic appearances on T1 and T2-weighted images.

Other

Electromyelography is not required but is beneficial in diagnosing neuropathies secondary to demyelination and inflammation [1].

The purpose of this study was to identify the prognostic factors associated with the need for surgical treatment in patients with lumbar spinal stenosis. [ncbi.nlm.nih.gov]

Common Treatments Medication Epidural steroid injections Physical therapy Activity modification Spinal stenosis surgery — usually as a last resort after exhausting less invasive treatment options Since stenosis is a mechanical problem, so patients often [secondopinion-spine.com]

The prognosis of Lumbar Spinal Stenosis may vary, but is good with early diagnosis and treatment The disorder can be difficult to prevent due to the risk factors increasing with age. [dovemed.com]

Radiological findings were mainly referred to for diagnosis, and clinical symptoms, age, radiological findings, and medical history were regarded to be important for prognosis. [ncbi.nlm.nih.gov]

The etiology of the condition is understood in only 75% of cases. There have been no prior reports of this condition following lumbar spine surgery carried out under hypotensive anesthetic. [ncbi.nlm.nih.gov]

The etiology is unknown but it is seen in achondroplasia 2. Central canal narrowing is the pertinent feature - various values have been proposed (AP mid-sagittal diameter 2,3. [radiopaedia.org]

(Etiology) Common causes associated with Lumbar Spinal Stenosis include: Past traumatic spinal injuries Children who are born with an abnormally narrow spinal canal (congenital spinal stenosis) Abnormal growths on the spine, such as a spinal tumor Ruptured [dovemed.com]

Epidemiological data suggest an incidence of 1 case per 100 000 for cervical spine stenosis and 5 cases per 100 000 for lumbar spine stenosis. Cervical myelopathy in patients over 50 years of age is most commonly due to cervical spine stenosis. [ncbi.nlm.nih.gov]

Congenital lumbar spinal stenosis is a type of spinal canal stenosis and has a different epidemiology with less severe degenerative change compared to acquired/degenerative lumbar spinal stenosis. [radiopaedia.org]

Introduction Narrowing of central or lateral lumbar spinal canal caused by degenerative joint disease leads to compression of nerve roots Epidemiology middle-aged or elderly Presentation Symptoms back pain and referred buttock pain neurogenic claudication [step2.medbullets.com]

This report is the first focused on the epidemiology of CSM on a national scale. [doi.org]

For this reason, the pathophysiology must be considered when selecting the suitable surgical procedure. [doi.org]

When the vertebrae extend back, the spinal canal and neuronal foramina naturally become narrower, and in flexion, become significantly wider. 14 This movement is a contributing pathophysiological cause of neurogenic intermittent claudication, which can [practicalpainmanagement.com]

This article reviews the pathophysiology, diagnosis, and management of lumbar spinal stenosis in adults over age 50 years. JoAnn Deasy is an adjunct professor in the PA program at Touro University California in Vallejo, Calif. [journals.lww.com]

How can Lumbar Spinal Stenosis be Prevented? Lumbar Spinal Stenosis is a progressive condition that is extremely difficult to prevent due to risk factors increasing with age. [dovemed.com]

It resists excessive separation of the adjacent vertebral lamina and prevents buckling of the ligament into the spinal canal during extension, preventing canal compression. [physio-pedia.com]

Management and Treatment of Spinal Stenosis Doctors are still investigating the most effective ways to prevent or delay spinal stenosis. [brighamhealthhub.org]

Can lumbar spinal canal stenosis be prevented or avoided? Lumbar spinal canal stenosis cannot really be prevented because it seems to be a part of getting older. [familydoctor.org]

1. Alvarez JA, Hardy RH. Lumbar Spine Stenosis: A Common Cause of Back and Leg Pain. Am Fam Physician. 1998;57(8):1825-1834.
2. Machado GC, Ferreira PH, Harris IA, et al. Effectiveness of Surgery for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis. Shamji M, ed. PLoS ONE. 2015;10(3):e0122800.
3. Ciricillo SF, Weinstein PR. Lumbar spinal stenosis. West J Med. 1993;158(2):171–7.
4. Genevay S, Atlas SJ. Lumbar Spinal Stenosis. Best Pract Res Clin Rheumatol. 2010;24(2):253-265.
5. Benoist M. The natural history of lumbar degenerative spinal stenosis. Joint Bone Spine. 2002;69(5):450–457.
6. Turner JA, Ersek M, Herron L, Deyo R. Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine. 1992;17(1):1–8.
7. Jenis LG, An HS. Spine update. Lumbar foraminal stenosis. Spine. 2000;25(3):389–94.
8. Inui Y, Doita M, Ouchi K, et al. Clinical and radiologic features of lumbar spinal stenosis and disc herniation with neuropathic bladder. Spine. 2004;29(8):869–73.
9. Matsumoto M, Watanabe K, Tsuji T, et al. Nocturnal leg cramps: a common complaint in patients with lumbar spinal canal stenosis. Spine. 2009;34(5):E189–94.
10. Chou R, Qaseem A, Owens DK, et al. Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Ann Intern Med. 2011;154(3):181-9.
11. Chou R, Qaseem A, Snow V, et al. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-491.