Lumbar spinal stenosis

Abstract

Spinal stenosis is a manifestation of several distinct etiologies that result in narrowing of the spinal canal. Degenerative changes involving the facet joints, intervertebral disks, and ligaments all may contribute to stenosis or exacerbate symptoms in the patient with congenitally narrowed canals. For most patients, spinal stenosis is successfully managed with activity modification, exercise, nonsteroidal anti-inflammatory drugs, and epidural injection. Correlating patient symptoms with radiographic evidence of neurologic compression helps ensure a more predictable outcome. Surgical intervention may be necessary in the patient with intractable pain, neurologic compromise, or mechanical instability. Various interventions exist, including microscopic laminectomy, lumbar laminoplasty, and lumbar laminotomy. Surgery should be individualized to address the specific spinal pathology and to allow for complete neurologic decompression. Using the principles of spinal surgery reviewed herein, one can expect improved patient outcomes. Copyright 2008 by the American Academy of Orthopaedic Surgeons.