Management of lumbar spinal stenosis

Abstract

Lumbar spinal stenosis (LSS) affects more than 200,000 adults in the United States, resulting in substantial pain and disability. It is the most common reason for spinal surgery in patients over 65 years. Lumbar spinal stenosis is a clinical syndrome of pain in the buttocks or lower extremities, with or without back pain. It is associated with reduced space available for the neural and vascular elements of the lumbar spine. The condition is often exacerbated by standing, walking, or lumbar extension and relieved by forward flexion, sitting, or recumbency. Clinical care and research into lumbar spinal stenosis is complicated by the heterogeneity of the condition, the lack of standard criteria for diagnosis and inclusion in studies, and high rates of anatomic stenosis on imaging studies in older people who are completely asymptomatic. The options for non-surgical management include drugs, physiotherapy, spinal injections, lifestyle modification, and multidisciplinary rehabilitation. However, few high quality randomized trials have looked at conservative management. A systematic review concluded that there is insufficient evidence to recommend any specific type of non-surgical treatment. Several different surgical procedures are used to treat patients who do not improve with non-operative therapies. Given that rapid deterioration is rare and that symptoms often wax and wane or gradually improve, surgery is almost always elective and considered only if sufficiently bothersome symptoms persist despite trials of less invasive interventions. Outcomes (leg pain and disability) seem to be better for surgery than for non-operative treatment, but the evidence is heterogeneous and often of limited quality.

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

“…Symptomatic lateral recess stenosis is typically first treated with conservative management includes NSAIDs, physiotherapy, spinal injections, lifestyle modification, and multidisciplinary rehabilitation (12). Surgery is recommended for patients who fail to response to nonsurgical treatments (13).…”

Comparison of minimally invasive and open transforaminal lumbar interbody fusion in the treatment of single segmental lumbar spondylolisthesis: minimum two-year follow up

“…Spondylolisthesis is one of the common disorders in lumbar spine region, and often results in lumbar stenosis, with symptoms of lower back pain, leg pain, neurogenic claudication and decreased function (1)(2)(3)(4). Surgical intervention is recommended if the symptoms can't be relieved by conservative therapy (5)(6)(7)(8)(9)(10).…”

Lumbar Stenosis of the Aging Spine: Evaluation and Treatment According to the Evidence Based Medicine for the Improvement of the Quality of Life

“…The exercise used for the recruitment of transversus and multifidus (muscles involved in lumbar stabilization) are: Abdominal drawing-in maneuver, active straight-leg raise and contralateral arm raise maneuver [19] [20] [21]. Before beginning with the exercise, in addition to the instructions, the physiotherapist shows to the patient the action of the muscles involved through ultrasound imaging; the evidences report that 5 minutes of biofeedback is the correct time to optimize performance [22].…”

“…LSS is caused by a gradual narrowing of the spinal canal or the intervertebral foramina which can compress the neural and vascular elements in the lumbar spine [2] [3] [4]. It is a degenerative process with predominantly affects the geriatric populations.…”