Update on lumbar spinal stenosis. Retrospective study of 62 patients and review of the literature.
OBJECTIVE
Although lumbar spinal stenosis syndrome is extremely common, considerable controversy continues to surround its classification, diagnosis, and treatment. We retrospectively reviewed the medical charts of 62 patients admitted for lumbar spinal stenosis syndrome, and we compared our findings to those in the literature. There were 31 women and 31 men. Mean age was 71.8 years. The most common symptoms were positional radiculopathy (92%) and low back pain (95%). The more suggestive sign of pseudoclaudication was observed in only 75% of cases, in keeping with earlier studies. Neurologic symptoms consisting primarily in mild motor loss were present in 15 patients.


RESULTS
The most common physical finding was pain during spinal extension (70%). Adopting a bent forward position during walking, a very suggestive manifestation, was seen in 15 patients. Imaging study findings included extensive changes in the discs and facet joints, disc protrusion, scoliosis, and degenerative spondylolisthesis. Myelography was rarely needed. There are no criteria sets for lumbar spinal stenosis syndrome. The diagnosis rests on clinical grounds, and extensive imaging studies are usually unnecessary. Our patients were treated with repeated corticosteroid injections into the thecal sac or epidural space and/or into the facet joints. Only eight patients required surgery.


CONCLUSIONS
Our study supports the view that most cases of lumbar spinal stenosis can be managed conservatively.
Radu
A S
AS
Department of Rheumatology, School of Medicine of the São Paulo University, Brazil.
Menkès
C J
CJ
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007278:Injections, Spinal; D017116:Low Back Pain / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013130:Spinal Stenosis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*
D000305:Adrenal Cortex Hormones