Lumbar spinal stenosis (LSS)

Extract

• The characteristic symptom of lumbar spinal stenosis (LSS) is neurogenic claudication (spinal claudication). When walking, the patient experiences pain (which usually starts in the back and radiates to the legs), numbness and/or weakness.
• If the symptoms are tolerable and the patient’s functional capacity is intact, the first-line management option is conservative treatment (including e.g. analgesia and physiotherapy).
• Consider surgery, if needed, after 3–6 months of conservative treatment.
• Indications for surgery include
  • unbearable or clearly interfering pain not relieved with conservative treatment
  • gradually shortening walking distance
  • progressing neurological deficit – LSS may be behind paraparesis
  • cauda equina syndrome (a rare situation: LSS usually progresses slowly).
• In rapidly progressive strength weakness, paraparesis, intolerable treatment-resistant pain or cauda equina situation, make an emergency referral; if the situation is unclear, consider a telephone consultation with an orthopaedist.

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Low Back Pain, M48.0, M99.6, Orthopaedics, Physical medicine, Sciatica, Spinal Canal, Spinal Nerve Roots, Surgery, cauda equina syndrome, claudication, spinal, lumbar spinal stenosis, lumbar spine, posterior pelvic tilt, spinal stenosis