title: Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment. Part VI: Lumbar Spinal Stenosis.
abstract: . To present the sixth in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. This article focuses on the evaluation and management of lumbar spinal stenosis (LSS), the most common condition for which older adults undergo spinal surgery.
  
  
  
  . The evaluation and treatment algorithm, a table articulating the rationale for the individual algorithm components, and stepped-care drug recommendations were developed using a modified Delphi approach. The Principal Investigator, a five-member content expert panel and a nine-member primary care panel were involved in the iterative development of these materials. The illustrative clinical case was taken from the clinical practice of a contributor's colleague (SR).
  
  
  
  . We present an algorithm and supportive materials to help guide the care of older adults with LSS, a condition that occurs not uncommonly in those with CLBP. The case illustrates the importance of function-focused management and a rational approach to conservative care.
  
  
  
  . Lumbar spinal stenosis exists not uncommonly in older adults with CLBP and management often can be accomplished without surgery. Treatment should address all conditions in addition to LSS contributing to pain and disability.
authors.affiliation: *Department of Physical Therapy and College of Health, University of Utah, Salt Lake City, Utah.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Fritz
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, Washington.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Rundell
authors.affiliation: Canandaigua VA Medical Center, Canandaigua, New York Department of Research, New York Chiropractic College, Seneca Falls, New York Division of Geriatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York.
authors.forename: Paul
authors.initials: P
authors.lastname: Dougherty
authors.affiliation: Hunter Holmes McGuire VA Medical Center, Richmond, Virginia **Virginia Commonwealth University Health System, Richmond, Virginia.
authors.forename: Angela
authors.initials: A
authors.lastname: Gentili
authors.affiliation: Canandaigua VA Medical Center, Canandaigua, New York Division of Geriatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York.
authors.forename: Gary
authors.initials: G
authors.lastname: Kochersberger
authors.affiliation: Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and.
authors.forename: Natalia E
authors.initials: NE
authors.lastname: Morone
authors.affiliation: Department of Anesthesiology, Critical Care Medicines, and Division of Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Srinivasa
authors.initials: S
authors.lastname: Naga Raja
authors.affiliation: Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and.
authors.forename: Eric
authors.initials: E
authors.lastname: Rodriguez
authors.affiliation: Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and.
authors.forename: Michelle I
authors.initials: MI
authors.lastname: Rossi
authors.affiliation: VITAS Healthcare, Miami, Florida; Departments of.
authors.forename: Joseph
authors.initials: J
authors.lastname: Shega
authors.affiliation: Physical Medicine and Rehabilitation, Orthopedic Surgery, Bioengineering.
authors.forename: Gwendolyn
authors.initials: G
authors.lastname: Sowa
authors.affiliation: Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and Psychiatry, and ****Anesthesiolgoy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Debra.Weiner@va.gov.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Weiner
mesh_terms: D000368:Aged; D059350:Chronic Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods*; D013130:Spinal Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*
keywords: Aged; Assessment; Chronic Low Back Pain; Chronic Pain; Elderly; Low Back Pain; Lumbar Spinal Stenosis; Primary Care; Spinal Stenosis