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Lumbar spinal stenosis (LSS)

Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal at the lumbar region which can compress the nerves of the lumbar vertebrae. This can cause lower back pain, leg cramping, or numbness/tingling in the lower extremities. Some patients may not experience any symptoms at all.

There are not many studies that research the incidence and prevalence of LSS.  It is estimated that over 200,000 adults have LSS and that number is expected to be 64 million in the elderly by the year 2025 (Wu et al., 2017).  The elderly population is affected by LSS more so than younger adults.  It is most often caused by degenerative disc disease and degenerative arthritis.  Osteoarthritis can also lead to LSS by damaging the spinal bones and wearing them down.  The pathology of lumbar spinal stenosis starts with degeneration of the facet joints, superior and inferior vertebral bodies, and discs.  The facets start degenerating causing synovitis that thins the cartilage and loosens the facet capsule, which allows for more spinal movement that causes degeneration and osteophytes (Lee et al., 2015).  The formation of the osteophytes narrows the spinal canal.

The pain associated with LSS can start slow and increase over time.  The pain can get so intense that the patient may not be able to walk due to excruciating pain.  Neurogenic claudication is the most common symptom associated with LSS causing pain in the buttocks, groins, anterior thighs, and down the posterior leg to the feet.  The pain will increase with lumbar extension and decrease with lumbar flexion (Lumbar Spinal Stenosis, n.d.).  The patient will present with a dull ache in the lower back that worsens with walking.

Treatment for LSS can start with simple lifestyle modifications.  The patient may need to lose weight and start a low impact exercise routine.  Patients can be treated with analgesics, physical therapy, and epidural steroid spinal injections.  Surgery is an option, but because the symptoms of the condition do not rapidly deteriorate and symptoms often gradually increase, the surgery is almost always considered elective (Lurie & Tomkins-Lane, 2016).  If non-surgical therapies do not improve symptoms with the move conservative therapies are when surgery is considered.  Patients need to be educated on what LSS is and what symptoms they can expect.  They also need to be educated on pain medication treatment options and physical therapy.  This is likely a chronic condition that will worsen over time.  The best option is to treat the symptoms until conservative treatments no longer work.  Follow up appointments should be made with worsening pain and an increase in symptoms.  Referrals may be made to neuro-surgeons or spinal institutes for treatment.


References:

Lee, S., Kim, T., Oh, J., Lee, S., & Park., M.  (2015).  Lumbar stenosis: A recent update by review of literature.  Asian Spine Journal, 9(5), 818-828.  doi:  10.4184/asj.2015.9.5.818.

Lumbar Spinal Stenosis.  Physiopedia.  Accessed on February 23, 2018 from https://www.physio-pedia.com/Lumbar_spinal_stenosis.

Lurie, J.  & Tomkins-Lane, C.  (2016).  Management of lumbar spinal stenosis.  British Medical Journal, 352, h6234.  doi: https://doi.org/10.1136/bmj.h6234.

Wu, A., Zou, F., Cao, Y., Xia., D., Wei, H., Zhu, B., Chen, D., …. Kawn, K.  (2017).  Lumbar spinal stenosis: an update on the epidemiology, diagnosis and treatment.  AME Medical Journal.  Accessed on February 23, 2018 from http://amj.amegroups.com/article/view/3837/4553.

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