Degenerative lumbar spinal stenosis - Review of the current diagnosis and treatment

Degenerative lumbar spinal stenosis (LSS) is a common cause of disabling back and leg pain, and spinal claudication among older persons. As the population grows older this condition is encountered more frequently. The degeneration of the intervertebral discs and the facet joints results in the narrowing of the spinal canal and neural foramina. Non-operative management is often of limited value and includes physical therapy, anti-inflammatory medications, and the injection of epidural steroids. The condition of a substantial portion of the patients does not deteriorate and remains unchanged. If non-operative treatment fails, surgical treatment should be considered. Surgical success rates as high as 90% have been reported. Few prospective studies have shown an advantage of operative treatment over non-operative treatment. A controversy exists pertaining to whether results in patients who have had surgery after failure of non-operative treatment were less satisfactory than results in patients who were operated at baseline. More randomized prospective studies are needed to obtain clear-cut conclusions regarding this controversy, and other controversies such as the exact role of surgical treatment.