Degenerative lumbar stenosis: diagnosis and management.

Full Abstract

Degenerative lumbar stenosis is a common cause of disabling back and lower extremity pain among older persons. The process usually begins with degeneration of the intervertebral disks and facet joints, resulting in narrowing of the spinal canal and neural foramina. Associated factors may include a developmentally narrow spinal canal and degenerative spinal instability. Nonoperative management includes restriction of aggravating activities, physical therapy, and anti-inflammatory medications. If nonoperative treatment has failed, surgical treatment may be appropriate. Decompression should be performed so as to address all clinically relevant neural elements while maintaining spinal stability. If instability is present, autogenous intertransverse bone grafting is recommended. There may be an advantage to augmenting some of these procedures with internal fixation. Surgical success rates as high as 85% have been reported, but may be compromised by inadequate decompression, inadequate stabilization, or medical comorbidities. Short-term follow-up data indicate that operative management provides more effective relief than nonoperative treatment, but prospective studies comparing the effects of nonoperative and operative interventions on the long-term natural history of lumbar spinal stenosis are needed.

Author information

Author/s: Hilibrand, A S (AS); Rand, N (N);

Affiliation: Rothman Institute at Thomas Jefferson University, Philadelphia, PA 19107, USA.

Journal and publication information

Publication Type: Journal Article; Review

Journal: The Journal of the American Academy of Orthopaedic Surgeons (J Am Acad Orthop Surg), published in UNITED STATES. (Language: eng)

Reference: -1999 Jul-Aug; vol 7 (issue 4) : pp 239-49

Dates: Created 1999/10/14; Completed 1999/10/14; Revised 2005/11/16;

PMID: 10434078, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

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