Lumbar stenosis: Prevalence, risk factors, and treatment

Lumbar spinal stenosis (LSS) is a clinical syndrome characterized by buttock and/or lower extremity pain with or without back pain secondary to degenerative spinal canal narrowing and compression of the neurovascular elements. LSS is the most common reason for spinal surgery in patients over 65 years of age. It results in significant pain and disability, compromising the quality of life and everyday activities of the affected patients. Pain is aggravated by certain postures, including walking, standing or lumbar extension and characteristically alleviated by recumbency, sitting and forward flexion. Initial treatment options include conservative management such as lifestyle modification, physiotherapy, epidural injections and medications. Very few randomized controlled clinical trials have assessed the role and the efficacy of non-surgical modalities for the management of patients with LSS and therefore there is a lack of sufficient evidence to suggest a specific method is superior. Surgical intervention is performed when there is failure of conservative management or neurologic emergency. Current techniques include open or minimally invasive approaches that aim at restoring spinal canal diameter and relieving neurovascular compromise.