Extract
The pain and disability associated with lumbar spinal stenosis can
interfere with patients' lifestyles, leading them to seek medical attention.
Typical symptoms of spinal stenosis (neurogenic claudication) include pain,
numbness, and paresthesias in the posterolateral aspects of the thighs and
legs. These symptoms usually radiate distally and are aggravated by prolonged
walking or standing. Activities in which the lumbar spine is in flexion, such
as walking uphill, leaning forward on a walker or shopping cart, or riding a
bicycle, are usually better tolerated by patients with neurogenic
claudication. It is crucial to distinguish between neurogenic and vascular
claudication when establishing the diagnosis of spinal
stenosis1.
Claudication of vascular etiology is usually associated with calf pain, which
may extend proximally. In peripheral vascular disease, lower-extremity pulses
are diminished and the symptoms are aggravated by activity in any position and
are relieved by rest in any position. Only after a clear diagnosis of
neurogenic claudication has been made and a vascular etiology has been ruled
out should treatment of spinal stenosis commence. Treatment options for
lowback pain and neurogenic claudication related to lumbar spinal stenosis
include nonoperative modalities, surgical decompression alone, or surgical
decompression and fusion with or without instrumentation. The treatment
approach is guided by the severity and duration of the symptoms, the type and
extent of the stenosis, any associated instability or deformity, the degree of
disc degeneration, and the presence of coexisting medical conditions.