Lumbar Stenosis

Background/Epidemiology

• Usually occurs in a congenitally narrow lumbar canal, combined with degenerative changes (loss of disc space; osteophytes and hypertrophy of the ligamentum flavum)
  • More common with age (usually 60+); also in hyperparathyroidism
• In contrast to cervical myelopathy, lumbar stenosis is more commonly due to obstruction to the blood supply of the spinal cord, rather than direct compression

Presentation

• Gradual onset unilateral or bilateral leg pain, numbness and weakness on exertion
  • In contrast to vascular claudication, spinal claudication may be eased by walking uphill; pulses are present but reflexes (ankle jerk) can be absent after exertion.
  • The pain may resemble that of spinal radiculopathy i.e. severe cramp like pain radiating from the lower back/buttocks down the back of the leg (cf vascular claudication which is characterised by severe calf pain)

Investigations

• MRI is the investigation of choice
  • X-ray may be done prior to exclude other diagnoses e.g. wedge fracture

Management

• Conservative management
  • weight reduction; physiotherapy and NSAIDs
• Surgical decompression and rehabilitation