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Abstract
Lumbar spinal stenosis is defined as the narrowing of the central lumbar canal, the lateral recess, or the intervertebral foramen. Although there are many causes of spinal stenosis, this study focused on the degenerative process. Degenerative changes and narrowing can occur centrally; in the lateral recess, leading to nerve-root impingement from an overhanging hypertrophic facet joint; within the nerve-root canal (foraminal stenosis); or extraforaminally, frequently because of entrapment by osteophytes, discs, transverse processes or the sacroiliac articulation for the fifth lumbar nerve root.
The clinical features of the disease are often subjective, vague, ill-described and lack substantiation on examination; therefore the history, rather than the objective findings, is the clue to reach a proper diagnosis. The typical symptoms of spinal stenosis include neurogenic claudication, back and leg pain, and mixed symptoms. Physical signs may include positive back signs, motor and sensory deficits, reflex changes and positive stretch signs. In many instances, the clinical examination may be completely normal. The pathophysiology of the symptoms is still controversial, but recent observations suggest that two-level stenosing pathology plays a significant role. Two-level venous compression, with venous pooling of one or several nerve roots, would explain some of the pathophysiology of neurogenic claudication.
Plain radiographs always show degenerative disease. They are essential to exclude other pathologies. The anatomical level of stenosis can not be determined from the history and examination alone. We have found that CT and MRI are satisfactory and can show central canal and lateral recess stenosis and nerve-root entrapment.