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Lumbar spinal stenosis is a common problem among older adults, and the prevalence increases with age.
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Consensus has been reached to define and diagnose clinical questions and radiologic criteria for lumbar spinal stenosis.
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MRI is the diagnostic modality of choice for the evaluation of lumbar spinal stenosis.
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Radiographic evidence of lumbar spinal stenosis is quite prevalent, although such findings may not correlate well with symptoms of lumbar spinal stenosis.
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Conservative and surgical therapies
Lumbar Spinal Stenosis in Older Adults
Section snippets
Key points
Epidemiology
Spinal stenosis is highly prevalent in older adults older than 60 years of age.2, 3 There is increasing prevalence among women with age, although men outnumbered women in the 50 to 60 and 60 to 69 age groups.2, 4 The prevalence of spinal stenosis in Japan was estimated to be about 5.7% to 10%,2, 4 and in the United States about 22.5%.3
Causes, associations
Spinal stenosis in the elderly may result from lumbar degenerative spondylolisthesis, particularly when it is accompanied by facet joint hypertrophy and thickening of the ligamentum flavum.1 In turn, this may lead to unilateral or bilateral radiculopathy and neurogenic claudication. In general, degenerative spine disorders and other arthritic conditions, compression deformities, congenital spine disorders, tumors, trauma, Paget's disease, fluorosis with secondary ossification, calcium deposits,
History and Physical Examination
A landmark study using the Delphi method achieved a consensus-based set of history-based items that act as a pragmatic set of criterion for defining and diagnosing LSS in clinical and research settings (Box 1, Section A).7 Within the first 6 questions, there was 80% certainty of LSS diagnosis. Consensus was achieved among 279 musculoskeletal medicine clinicians, including 3 rheumatologists. Furthermore, clinical criteria independently associated with neurogenic claudication due to LSS were
Imaging
There are multiple imaging and diagnostic modalities available to evaluate LSS (Table 1); however, clear gold-standard diagnostic criteria have yet to be established. Among the available studies, MRI without contrast is the modality of choice to verify the presence of spinal canal narrowing or nerve root compression.16, 17
Imaging is a mainstay in the evaluation of spinal stenosis. However, medical decision making relies heavily on the clinical acumen of the physician in consideration of
Treatment
Treatment recommendations specific to the elderly population are not available because of lack of high-quality studies.30
Summary
LSS is a frequent cause of LBP among adults and may be due to several conditions. Despite the utility of MRI or CT, radiographic evidence of LSS may not correlate well with symptoms. An increase in utilization of surgery has been noted, although surgery has shown no significant benefit over more conservative options. Ultimately, the decision to pursue surgical intervention should require a well-thought-out interdisciplinary effort by identifying comorbidities and possible risks of various
References (58)
- et al.
Prevalence of lumbar spinal stenosis, using the diagnostic support tool, and correlated factors in Japan: a population-based study
J Orthop Sci
(2013) - et al.
Spinal stenosis prevalence and association with symptoms: Framingham study
Spine J
(2009) - et al.
Prevalence of symptomatic lumbar spinal stenosis and its association with physical performance in a population-based cohort in Japan: the Wakayama Spine Study
Osteoarthritis Cartilage
(2012) - et al.
Longitudinal construct validity and responsiveness of measures of walking capacity in individuals with lumbar spinal stenosis
Spine J
(2014) - et al.
An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update)
Spine J
(2013) - et al.
Associations between radiographic lumbar spinal stenosis and clinical symptoms in the general population: the Wakayama Spine Study
Osteoarthritis Cartilage
(2013) - et al.
Spine surgery outcomes in elderly patients versus general adult patients in the United States: a MarketScan analysis
World Neurosurg
(2017) - et al.
Low back pain in older adults: risk factors, management options and future directions
Scoliosis Spinal Disord
(2017) - et al.
Diffuse idiopathic skeletal hyperostosis is associated with lumbar spinal stenosis requiring surgery
J Bone Miner Metab
(2018) - et al.
Characteristics and determinants of clinical symptoms in radiographic lumbar spinal stenosis in a tertiary health care centre in sub-Saharan Africa
BMC Musculoskelet Disord
(2017)
ISSLS Prize Winner: consensus on the clinical diagnosis of lumbar spinal stenosis: results of an International Delphi Study
Spine (Phila Pa 1976)
Clinical classification criteria for neurogenic claudication caused by lumbar spinal stenosis. The N-CLASS criteria
Spine J
Comparison of radicular symptoms caused by lumbar disc herniation and lumbar spinal stenosis in the elderly
Spine (Phila Pa 1976)
Three-minutes sitting test for evaluating lumbar foraminal stenosis: a preliminary report
J Spinal Cord Med
The tibial nerve compression test for the diagnosis of lumbar spinal canal stenosis---a simple and reliable physical examination for use by primary care physicians
Acta Orthop Traumatol Turc
Diagnostic value of the lumbar extension-loading test in patients with lumbar spinal stenosis: a cross-sectional study
BMC Musculoskelet Disord
Diagnosis of lumbar spinal stenosis
Spine
Clinical practice. Lumbar spinal stenosis
N Engl J Med
Cervical spine instability in the course of rheumatoid arthritis-imaging methods
Reumatologia
Consensus conference on core radiological parameters to describe lumbar stenosis---an initiative for structured reporting
Eur Radiol
Correlation between disability and MRI findings in lumbar spinal stenosis: a prospective study of 109 patients operated on by decompression
Acta Orthop
Spinal canal size and clinical symptoms among persons diagnosed with lumbar spinal stenosis
Clin J Pain
The influence of pain sensitivity on the symptom severity in patients with lumbar spinal stenosis
Pain Physician
Is there an association between pain and magnetic resonance imaging parameters in patients with lumbar spinal stenosis?
Spine
Degenerative lumbar spinal canal stenosis: intra- and inter-reader agreement for magnetic resonance imaging parameters
Eur Spine J
The significance of spinal canal dimensions in discriminating symptomatic from asymptomatic disc herniations
Eur Spine J
The sensitivity and specificity of electrodiagnostic testing for the clinical syndrome of lumbar spinal stenosis
Spine (Phila Pa 1976)
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