Lumbar Spinal Stenosis
Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal, lateral recesses, or neural foramina in the lumbar spine that results in compression of neural structures. It is the most common reason for spinal surgery in adults over 65 and is typically caused by degenerative changes including disc bulging, facet joint hypertrophy, and ligamentum flavum thickening.
Symptoms
- Neurogenic claudication — bilateral leg heaviness, pain, or fatigue with walking
- Symptom relief with flexion (leaning forward on a shopping cart)
- Pain typically bilateral and non-dermatomal
- Lumbar radiculopathy if foraminal stenosis
- Worse with extension, better with rest
- Reduced walking tolerance over time
Causes
- Degenerative disc disease
- Facet joint hypertrophy
- Ligamentum flavum hypertrophy/buckling
- Spondylolisthesis (dynamic instability)
- Prior surgery (epidural fibrosis)
- Congenital (developmental) stenosis
Diagnosis
Accurate diagnosis is essential for effective treatment. Clinicians typically use a combination of:
- Clinical presentation of neurogenic claudication
- Lumbar MRI — gold standard
- CT scan for bony anatomy detail
- CT myelogram for dynamic assessment
- X-ray with flexion/extension views for instability
- Quantitative CT morphometry for canal measurements
Treatment Approaches
Related Procedures
🚨 Red Flags
Seek urgent medical evaluation if you experience any of the following:
- ⚠️ Cauda equina syndrome
- ⚠️ Rapidly progressive neurological deficit
- ⚠️ Intractable pain unresponsive to all conservative measures
Frequently Asked Questions
Related Conditions
Sciatica
Sciatica refers to pain that radiates along the path of the sciatic nerve, from the lower back through the hips and buttocks and down the leg. It typically affects one side of the body and is caused by compression of the sciatic nerve roots (L4-S3), most commonly from a lumbar disc herniation or foraminal stenosis.
Facet Joint Syndrome
Facet joint syndrome (zygapophyseal joint syndrome) is pain arising from the facet joints of the spine due to degenerative changes, injury, or inflammation. It is a common cause of chronic spinal pain and is diagnosed clinically and confirmed with diagnostic medial branch blocks.
You May Also Want to Understand
Sciatica
Sciatica refers to pain that radiates along the path of the sciatic nerve, from the lower back through the hips and buttocks and down the leg. It typically affects one side of the body and is caused by compression of the sciatic nerve roots (L4-S3), most commonly from a lumbar disc herniation or foraminal stenosis.
Cervical Radiculopathy
Cervical radiculopathy is pain, numbness, or weakness caused by compression or irritation of a cervical nerve root. It most commonly results from disc herniation or foraminal stenosis and typically affects the C6 or C7 nerve roots.
Facet Joint Syndrome
Facet joint syndrome (zygapophyseal joint syndrome) is pain arising from the facet joints of the spine due to degenerative changes, injury, or inflammation. It is a common cause of chronic spinal pain and is diagnosed clinically and confirmed with diagnostic medial branch blocks.
Sacroiliac Joint Dysfunction
Sacroiliac (SI) joint dysfunction refers to pain originating from the sacroiliac joint complex, a common but often underdiagnosed cause of low back and buttock pain. The SI joint transmits forces between the spine and lower extremities and can become painful through inflammatory, degenerative, or traumatic mechanisms.
Dr. Shahnawaz F Shah
Interventional Spine & Pain Physician
Dr. Shah specializes in the diagnosis and management of lumbar spinal stenosis using evidence-based approaches tailored to each patient's needs.
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