Diagnosis And Treatment Of Degenerative Lumbar Spinal Stenosis

Degenerative lumbar spinal stenosis describes a condition in which there is diminished space available for the neural and vascular elements in the lumbar spine secondary to degenerative changes in the spinal canal. When symp- tomatic, this causes a variable clinical syndrome of gluteal and/or lower extremity pain and/or fatigue that may occur with or without back pain. Symptomatic lumbar spinal stenosis has certain characteristic provocative and palliative features. Provocative features include upright exercise such as walking or positionally induced neurogenic claudication. Palliative features commonly include symptomatic relief with forward flexion, sitting, and/or recumbency. (, )

In the absence of reliable evidence, it is the work group’s opinion that the natural history of patients with clinically mild to moderately symptomatic degenerative lumbar steno- sis can be favorable in about one-third to one-half of patients. (, )

In the absence of reliable evidence, it is the work group’s opinion that in patients with mild or moderately symptom- atic degenerative lumbar stenosis, rapid or catastrophic neurologic decline is rare.

In the absence of reliable evidence, it is the work group’s opinion that information in the literature is insufficient to define the natural history of clinically or radiographically severe degenerative lumbar stenosis.