CHARLES W. WEBB, DO, KENNETH AGUIRRE, MD, AND PETER H. SEIDENBERG, MD
Am Fam Physician. 2024;109(4):350-359
This clinical content conforms to AAFP criteria for CME.
Author disclosure: No relevant financial relationships.
Lumbar spinal stenosis is a clinical syndrome that affects more than 200,000 people in the United States annually. It is a common cause of chronic insidious low back pain, especially in older patient populations (mean age = 64 years). Lumbar spinal stenosis is a degenerative condition of the spine leading to narrowing in the spaces around the neurovascular bundles and the classic symptom of low back pain that radiates to the buttocks and lower extremities bilaterally. It is typically a progressive waxing and waning process that may deteriorate over years. The pain is typically burning or cramping, which worsens with standing and walking and improves with bending forward or sitting. Magnetic resonance imaging is the recommended diagnostic test because it allows cross-sectional measurement of the spinal canal. Options for nonsurgical management include physical therapy, exercise programs, spinal injections with and without corticosteroids, chiropractic treatment, osteopathic manipulation, acupuncture, and lifestyle modifications; however, few of these treatments have high-quality randomized trials demonstrating effectiveness. Surgery may be considered if nonsurgical management is ineffective.
Up to 90% of the U.S. population will experience significant low back pain (i.e., pain requiring the patient to seek medical care or miss work) in their lifetime. 1 – 3 Low back pain becomes chronic in up to 23% of patients and recurs within one year in up to 80%. 2 , 4 Lumbar spinal stenosis is a common cause of chronic low back pain, particularly in people older than 50 years, and is a progressive degenerative condition of the intervertebral disk, ligamentum flavum, and facet joints secondary to aging. It causes a narrowing in the spaces encompassing the neurovascular structures of the spine, leading to the characteristic clinical syndrome of buttock and bilateral lower extremity pain that may include the lower back. 3 The pain typically worsens with walking or standing and improves with sitting or leaning forward. 5 – 8 Figure 1 shows normal spinal anatomy. 3