Lumbar Spinal Stenosis in Older Adults

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Key points

  • Lumbar spinal stenosis is a common problem among older adults, and the prevalence increases with age.

  • Consensus has been reached to define and diagnose clinical questions and radiologic criteria for lumbar spinal stenosis.

  • MRI is the diagnostic modality of choice for the evaluation of lumbar spinal stenosis.

  • Radiographic evidence of lumbar spinal stenosis is quite prevalent, although such findings may not correlate well with symptoms of lumbar spinal stenosis.

  • Conservative and surgical therapies

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

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    Conflict of Interest/Disclosure: None for either author.

    Financial Support: None.

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