In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves revisit lumbar stenosis with neurogenic claudication with a journal club of some recent literature. The studies will look at epidemiology, treatment options, and data regarding its impact on mobility / exercise.  

 

Lumbar stenosis is defined as any type of narrowing of the spinal canal, nerve root canals, or intervertebral foramina; it may be local, segmental, or generalized, it may be caused by bone or soft tissue and the narrowing may involve the bony canal alone, the dural sac, or both.  Lumbar stenosis is a common disease process, and depending on the criteria employed for diagnosis the prevalence in the general adult population ranges from 11-39% (this range also highlights the need for optimization / standardization of the diagnostic criteria for this disease).  The classical clinical presentation of lumbar stenosis with neurogenic claudication is lower limb symptoms (including deep muscular pain, cramping, altered strength/sensation) with or without low back pain, that is very much accentuated by standing and walking, and alleviated by sitting down or lumbar flexion (shopping cart sign).  

 

Treatment options include: lifestyle modifications (diet, exercise, weight optimization), activity modifications, physical therapy, lumbosacral orthosis, medications (caution in this typically elderly population with potential fall risk), epidural steroid injections, minimally invasive surgical intervention (including Minimally Invasive Lumbar Decompression (MILD), and Interspinous Process Decompression), and decompression with or without hardware.  Interspinous Process Decompression is a supported by multiple studies including 5 year clinical outcome data demonstrating efficacy for pain and function.  In this podcast discussion the doctors also highlight the cost effectiveness of Interspinous Process Decompression relative to other approaches to treatment.  

 

Listen as the doctors discuss this important and highly prevalent disease process, including a review of recent studies that highlight some important aspects of this disease process including the fact that based upon the best available evidence only about 4% of patients with lumbar stenosis with neurogenic claudication are able to meet the recommended level of physical activity per week.  

 

This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.

References:

1. Prevalence of lumbar spinal stenosis in general and clinical populations: a systematic review and meta-analysis. European Spine Journal. 2020.

2. Objective measurement of free-living physical activity (performance) in

lumbar spinal stenosis: are physical activity guidelines being met?. The Spine Journal. 2017.

3. Cost-effectiveness and Safety of Interspinous Process Decompression (Superion). Pain Medicine. 2019.

4. The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment. Pain Practice. 2018.

5. Five-year durability of stand-alone interspinous process decompression for lumbar spinal stenosis. Clinical Interventions in Aging. 2017.