Lumbar spinal stenosis clinical features

Typically causes low back or buttock pain, sensory and motor disturbances, and neurogenic intermittent claudication in the lower extremities.

Upon progressive narrowing of the lumbar spinal canal, patients start to develop the typical symptoms due to compression of the roots of the cauda equina: leg pain (frequently in both legs), exacerbated by walking, prolonged standing or lumbar extension, and sometimes associated back pain ¹⁾ ²⁾ ³⁾.

The characteristic clinical manifestations of LSS include periodic exacerbations of low back and leg pain and neurogenic claudication, with resulting compromise in health-related quality of life, mobility, and independence ⁴⁾.

The symptoms include back pain, aching and cramping of the leg, neurogenic claudication, muscle spasm, neurological deficits including numbness and paraesthesia, reflex loss, motor weakness, muscle atrophy and sphincter disturbance ⁵⁾ ⁶⁾.

Symptoms may radiate from the buttocks to the distal lower extremities and are often accompanied with paraesthesias. In contrast to sciatica symptoms are generally bilateral and localized poorly ⁷⁾.

Lumbar pain

The median duration of lumbar pain occurred 14 years (range 0–60 years) before treatment started

Radicular pain

The mean duration of radicular pain before treatment was 2 years (range 0–37 years).

¹⁾

Deyo RA, Gray DT, Kreuter W, Mirza S, Martin BI. United States trends in lumbar fusion surgery for degenerative conditions. Spine (Phila Pa 1976) 2005;30(12):1441–1445. doi: 10.1097/01.brs.0000166503.37969.8a.

²⁾

Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010;303(13):1259–1265. doi: 10.1001/jama.2010.338.

³⁾

Deyo RA, Nachemson A, Mirza SK. Spinal-fusion surgery—the case for restraint. N Engl J Med. 2004;350(7):722–726. doi: 10.1056/NEJMsb031771.

⁴⁾

Weiner DK. Office management of chronic pain in the elderly. Am J Med. 2007;120:306–315.

⁵⁾

Arnoldi CC, Brodsky Ae, Cauchoix J, et al. Lumbar spinal stenosis and nerve root entrapment syndromes. Definition and classification. Clin Orthop 1976; 115:4-5.

⁶⁾

Domagoj C, Charles LB. Posterior lumbar interbody fusion in the treatment of symptomatic spinal stenosis. Neurosurg Focus 1997; 3(2): article 5.

⁷⁾

Amundsen T, Weber H, Lilleas F, Nordal HJ, Abdelnoor M, Magnaes B. Lumbar spinal stenosis. Clinical and radiologic features. Spine (Phila Pa 1976) 1995;20(10):1178–1186.