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
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