Lumbar Spinal Stenosis

Part 1

Richard G. Fessler, MD, PhD
Professor of Neurological Surgery
Northwestern University
Chicago, IL

Larry T. Khoo, M.D.
Neurosurgery Assistant Professor, Neurosurgery and Orthopedics
UCLA Medical Center, Neurosurgery
Los Angeles, CA

Lumbar spinal stenosis is a result of aging and everyday wear and tear on the spine. Though these changes happen to all of us, not everyone will experience the symptoms of lumbar spinal stenosis (LSS). Features of LSS include persistent, progressive low back pain with or without radiation, numbness or weakness in the buttocks and legs, and symptoms that improve with resting, lying down or bending forward. Unfortunately, many patients with symptoms of spinal stenosis often suffer for a long period of time before seeking medical advice and, even then, can often be misdiagnosed and treated inappropriately. As such, many older people with LSS have had to give up active lifestyles despite conservative treatment with rest, medication, and physical therapy.

What Happens in Lumbar Stenosis?

In the normal spinal canal, the nerve roots are contained in the thecal sac and exit between each vertebra (foramina). The central spinal canal and the foramen contain the thecal sac and nerve roots respectively.

Figure 1

The canal and foramen are formed (Figure 1) by bony structures (vertebral body, facets, pedicles) as well as soft tissue structures (ligamentum flavum, facet capsules, intervertebral disc annulus). As we age, degenerative changes occur in our spine causing narrowing of the central spinal canal area, and/or the area where the nerve roots exit the spinal canal (foramina). One of these degenerative changes is the formation of extra bony growths called osteophytes. Additionally, the large connective "band" (ligamentum flavum) which runs along the inside the spinal canal can become coarse and thickened also causing narrowing of the central canal space.

Lali Sekhon, MD, PhD, FRACS, FICS



This study gives an excellent overview of what is a very common spinal condition. The etiology, manifestations and management of spinal stenosis are covered very well. A few comments need to be made. Myelography is rarely used as a primary investigative tool with the widespread availability of MR scanning. Minimally-invasive laminectomy is certainly not standard of care in the management of spinal stenosis and most surgeons perform open laminectomies very successfully. In all but experienced hands, complication rates from minimally-invasive laminectomy may be higher than open laminectomy. All patients who are considering surgical intervention or suffer from spinal stenosis should read this thorough and thoughtful review. Fessler et al provide a comprehensive and complete guide to this condition and its management.

• How Do You Get Lumbar Spinal Stenosis?
• Symptoms of Lumbar Spinal Stenosis
• Am I a Candidate for the Total Facet Arthroplasty System™ (TFAS ™) Clinical Trial?
• Diagnostic Studies to Evaluate Lumbar Spinal Stenosis
• Options to Treat Lumbar Spinal Stenosis: Medication, Physical Therapy, Surgery
• Spinal Stenosis: Lumbar and Cervical