Lumbar spinal stenosis is defined as a degenerative condition in which there is diminished space available within the spinal canal, or spinal foramen, for the neural and/or vascular elements in the lumbar spine. Narrowing within the spine is most often due to age-related changes that take place over time. This is called "acquired spinal stenosis" and is most common in people over 50 years of age. Acquired forms of LSS can be subclassified as degenerative, spondylolisthesis - that is to say one vertebrae has slipped forward on another; iatrogenic - which is the result of post medical intervention, or examination usually postsurgical; posttraumatic, or it in some cases can be a combination of the above. For example, someone who has a historical spondylolisthesis may have degenerative changes as a result of that specific issue, which in turn leads to spinal stenosis but, like with many conditions, no two cases will be the same. Importantly, lumbar spinal stenosis is associated with substantial functional limitation of walking, disability, and an increased risk of falling. Given the impact on quality of life, as well as the additional risks, effective management is important.

In this episode, we discuss lumbar spinal stenosis and the common presenting symptoms that we find associated with this condition. We identify some of the common patterns related to the problem, such as patients leaning forward to alleviate their symptoms, which helps to identify the problem. In addition, we discuss some of the diagnostic tests used to diagnose the condition as well as the treatment options that will likely be considered to help manage symptoms.

Some of the things you’ll discover…

• The average age of patients suffering from lumbar spinal stenosis
• Which tissues are commonly the culprit of spinal canal, or foramen, narrowing?
• What are the common symptoms associated with lumbar spinal stenosis?
• The difference between neurogenic and vascular, claudication and how to differentiate the two
• Why bending backwards can often increase the symptoms a patient will experience
• Some of the different treatment options available for the management of symptoms associated with stenosis

Highlights

Spinal surgery is often an early treatment approach for patients with lumbar spinal stenosis. However, given the average age of the patient, and the associated risk factors, taking a conservative approach should be the first line approach in the management of this condition. Given the additional health benefits to people in this age category a physical therapy approach would be of benefit, although the research evidence directing specific exercise choice is still limited. Long term outcome to surgery does demonstrate clinical benefit but should always remain a consideration further along the management pathway.

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