lumbar spinal stenosis is a degenerative condition characterized by narrowing of the lumbar spinal canal due to -
■ bony structures
■ facet osteophytes
■ uncinate spur (posterior vertebral body osteophyte)
■ spondylolisthesis
■ soft tissue structures
■ herniated or bulging discs
■ hypertrophy or buckling of the ligamentum flavum
■ synovial facet cysts
Causes -
- Arthritis
- Wear and tear on the spine’s bones and joints.
- Trauma
- Falls
Symptoms -
- back pain
- referred buttock pain
- leg pain is often unilateral
- neurogenic claudication
* pain worse with extension (walking, standing upright)
* pain relieved with flexion (sitting, leaning over shopping cart, sleeping in fetal position) - weakness
- bladder disturbances - recurrent UTI present in up to 10% due to autonomic sphincter dysfunction
- cauda equina syndrome (rare)
Investigations -
- Manual tests
- CT myelogram
- MRI
- Radiographs
Treatment -
Nonoperative
- oral medications, physical therapy, and corticosteroid injections.
- modalities include-
*NSAIDS, physical therapy, weight loss and bracing
*steroid injections (epidural and transforaminal)
*found to be effective and may obviate the need for surgery - Operative.
