Lumbar spinal stenosis: a review

Abstract

Neurologic compromise due to degenerative disorders of the lumbar spine are designated by the generic term "lumbar spinal stenosis". Differences in the interpretation of this term exist across the fields of pathology, radiology, and rheumatology, creating significant confusion. Rheumatologists view lumbar spinal stenosis as a functional rather than an anatomic entity and hold that its diagnosis should be based on clinical grounds. As in disk disease, imaging studies lack sensitivity and specificity, are poorly correlated with the level and severity of manifestations and are of no assistance for predicting the preoperative or postoperative outcome. A detailed history is the mainstay of the diagnosis and also carries great weight for estimating the level of impairment due to spinal stenosis. In contrast, "objective" physical findings have little predictive value and are poorly correlated with both quality of life indicators and postoperative outcomes. The effect of surgery remains unpredictable in the individual patient. Remarkable uniformity has occurred among published series regarding the rate of poor surgical outcomes (about one case in three), postsurgical worsening of symptoms (one case in six) and postsurgical complications (one case in ten). Accurate data are lacking on the short-term and long-term efficacy of conservative therapy (local corticosteroid injections and kinesiology). Randomized studies are needed to compare conservative therapy and surgery in terms of quality of life and other long-term outcomes in patients who fail initially to respond to conservative management. Improved knowledge of the natural history of this ill-defined syndrome is among the benefits expected from such studies.