Condition typically resulting from degenerative changes in the lumbar spine.
Neurogenic claudication characterised by back and leg pain and lower extremity paraesthesia brought on by ambulation and relieved by sitting.
Lumbosacral spine x-rays and computed tomography scans show degenerative changes and possibly spondylolisthesis, but magnetic resonance imaging is the best technique to show neural element compression in the spinal canal and foramina.
Initially treated with non-steroidal anti-inflammatory drugs and physiotherapy. Epidural corticosteroid injections may provide symptomatic relief.
More severe or persistent symptoms that significantly interfere with function are likely to benefit from decompressive spinal surgery, possibly with fusion if there is degenerative spondylolisthesis or degenerative scoliosis.
Neurological deficit including sensory or motor loss occurs in up to 30% of patients, and patients may experience severe morbidity from reduction in the ability to walk.
Lumbar spondylosis refers to degenerative conditions of the lumbar spine that narrow the spinal canal, lateral recesses, and neural foramina. Facet joint and ligamentous hypertrophy, intervertebral disc protrusion, and spondylolisthesis may all contribute to the stenosis, and symptoms result from neural compression of the cauda equina, exiting nerve roots, or both. Patients present with symptoms of neurogenic claudication or radiculopathy.
History and exam
Adam M. Pearson, MD, MS
Assistant Professor of Orthopaedic Surgery
Dartmouth-Hitchcock Medical Center
AMP is an author of a number of references cited in this topic.
Dr Adam M. Pearson would like to gratefully acknowledge Dr William A. Abdu, Dr John K. Houten, and Dr Mark Chwajol, previous contributors to this topic. WAA is an author of a reference cited in this topic. JKH and MC declare that they have no competing interests.
John Ratliff, MD, FAANS, FACS
Department of Neurosurgery
JR declares that he has no competing interests.
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