Lumbar Spinal Stenosis
Narrowing of the central canal, lateral recess, or foramen of the lumbar spine producing neurogenic claudication in older adults.
Overview
Degenerative lumbar stenosis is the most common reason for spine surgery in patients over 65. Disc-space loss, facet and ligamentum flavum hypertrophy, and osteophyte formation narrow the space available for neural elements, compromising vascular supply and mechanical function of the cauda equina.
Epidemiology
Radiographic stenosis is present in up to 20 percent of asymptomatic adults over 60. Symptomatic stenosis accounts for several hundred thousand procedures per year worldwide and is expected to grow with an ageing population.
Symptoms
Neurogenic claudication - bilateral buttock and leg pain, heaviness or weakness on walking or standing, relieved by forward flexion or sitting - is the classic syndrome. Patients describe a 'shopping trolley sign' of improved symptoms with flexion. Unlike vascular claudication, symptoms are provoked by standing even without walking and relieved by posture rather than rest.