Lumbar Spinal Stenosis: Pathophysiology and Treatment Principle: A Narrative Review

Abstract

Patients with lumbar spinal stenosis may exhibit symptoms such as back pain, radiating pain, and neurogenic claudication. Although long-term outcome of treatments manifests similar results for both nonsurgical and surgical treatments, positive effects such as short-term improvement in symptoms and decreased fall risk may be expected with surgery. Surgical treatment is basically decompression, and a combination of treatments can be added depending on the degree of decompression and the accompanying instability. Recently, minimally invasive surgery has been found to result in excellent outcomes in the treatment of lumbar spinal stenosis. Therefore, better treatment effects can be anticipated with an approach aimed at understanding the overall pathophysiology and treatment methods of lumbar spinal stenosis.

Keywords: Diagnosis; Pathophysiology; Spinal stenosis; Surgery; Treatment.

Fig. 1.

Magnetic resonance imaging image in patients with spinal stenosis. (A, B) In the sagittal image scan, central stenosis and resultant crowding of cauda equina are seen (arrow in red). (C, D) In the axial scan, the stenosis segment can be easily compared with the normal segment (arrow in blue).

Fig. 2.

(A–D) Spondylolytic spondylolisthesis and related hypertrophy of fibrocartilage complex and resultant stenosis are demonstrated in X-ray, sagittal T1 weighted magnetic resonance imaging scan, and axial computed tomography scan in order (arrows).

Fig. 3.

(A–D) In a sagittal T1 weighted magnetic resonance imaging scan, foraminal stenoses are well visualized with loss of perineural fat tissue compared with normal foramen (arrows in red). Rt., right; Lt., left.

Fig. 4.

Magnetic resonance imaging scan in a patient with degenerative scoliosis (A). (B–D) When the spinal column is out of the scan range in the sagittal plane, an inaccurate noncontinuous image scan is acquired. (E) In an axial scan, the rotation of the vertebra is easily seen.

Fig. 5.

Sixty-one-year-old female patient with central stenosis. (A–D) On magnetic resonance imaging sagittal and axial scan, central stenosis with cyst in ligamentum flavum and facet arthrosis are seen (arrow). (E, F) Decompression and posterolateral fusion with instrumentation between L4–5 were done.

Fig. 6.

Seventy-five-year-old male patient with degenerative spondylolisthesis. (A–D) On dynamogram, degree of listhesis increased on flexion radiography. (E–H) On magnetic resonance imaging sagittal and axial scan, spondylolisthesis and stenosis with facet hypertrophy and thickening of ligamentum flavum is seen. (I, J) Decompression and posterior lumbar interbody fusion with instrumentation between L4–5 were done.