Lumbar spinal stenosis: Pathophysiology, clinical features, and diagnosis
- Kerry Levin, MD
Kerry Levin, MD
- Chairman, Department of Neurology
- Cleveland Clinic
- Cleveland Clinic Lerner College of Medicine
- Section Editors
- Michael J Aminoff, MD, DSc
Michael J Aminoff, MD, DSc
- Editor-in-Chief — Neurology
- Section Editor — Medical Neurology
- Professor of Neurology
- University of California, San Francisco School of Medicine
- Steven J Atlas, MD, MPH
Steven J Atlas, MD, MPH
- Section Editor — Spinal disease and back pain
- Associate Professor of Medicine
- Harvard Medical School
The term lumbar spinal stenosis can refer to one or more of the following anatomic states:
●Narrowing of the intraspinal (central) canal
●Narrowing of the lateral recess
●Narrowing of the neural foramen
This topic will focus on the pathophysiology, clinical features, and diagnosis in regard to stenosis of the intraspinal (central) lumbar canal. This condition, most commonly caused by degenerative bone disease, is increasingly recognized as a cause of disability in the aging population [1,2].
- Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med 2008; 358:818.
- Ciol MA, Deyo RA, Howell E, Kreif S. An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. J Am Geriatr Soc 1996; 44:285.
- Binder DK, Schmidt MH, Weinstein PR. Lumbar spinal stenosis. Semin Neurol 2002; 22:157.
- Atlas SJ, Delitto A. Spinal stenosis: surgical versus nonsurgical treatment. Clin Orthop Relat Res 2006; 443:198.
- Venkatesan M, Uzoigwe CE, Perianayagam G, et al. Is cauda equina syndrome linked with obesity? J Bone Joint Surg Br 2012; 94:1551.
- Battié MC, Ortega-Alonso A, Niemelainen R, et al. Lumbar spinal stenosis is a highly genetic condition partly mediated by disc degeneration. Arthritis Rheumatol 2014; 66:3505.
- Jinkins JR. Gd-DTPA enhanced MR of the lumbar spinal canal in patients with claudication. J Comput Assist Tomogr 1993; 17:555.
- Takahashi K, Kagechika K, Takino T, et al. Changes in epidural pressure during walking in patients with lumbar spinal stenosis. Spine (Phila Pa 1976) 1995; 20:2746.
- Rydevik B. Neurophysiology of cauda equina compression. Acta Orthop Scand Suppl 1993; 251:52.
- Ooi Y, Mita F, Satoh Y. Myeloscopic study on lumbar spinal canal stenosis with special reference to intermittent claudication. Spine (Phila Pa 1976) 1990; 15:544.
- Watanabe R, Parke WW. Vascular and neural pathology of lumbosacral spinal stenosis. J Neurosurg 1986; 64:64.
- Baker AR, Collins TA, Porter RW, Kidd C. Laser Doppler study of porcine cauda equina blood flow. The effect of electrical stimulation of the rootlets during single and double site, low pressure compression of the cauda equina. Spine (Phila Pa 1976) 1995; 20:660.
- Kaiser MC, Capesius P, Roilgen A, et al. Epidural venous stasis in spinal stenosis. CT appearance. Neuroradiology 1984; 26:435.
- Ikawa M, Atsuta Y, Tsunekawa H. Ectopic firing due to artificial venous stasis in rat lumbar spinal canal stenosis model: a possible pathogenesis of neurogenic intermittent claudication. Spine (Phila Pa 1976) 2005; 30:2393.
- Porter RW. Spinal stenosis and neurogenic claudication. Spine (Phila Pa 1976) 1996; 21:2046.
- Porter RW, Ward D. Cauda equina dysfunction. The significance of two-level pathology. Spine (Phila Pa 1976) 1992; 17:9.
- Hamanishi C, Matukura N, Fujita M, et al. Cross-sectional area of the stenotic lumbar dural tube measured from the transverse views of magnetic resonance imaging. J Spinal Disord 1994; 7:388.
- Inufusa A, An HS, Lim TH, et al. Anatomic changes of the spinal canal and intervertebral foramen associated with flexion-extension movement. Spine (Phila Pa 1976) 1996; 21:2412.
- Hall S, Bartleson JD, Onofrio BM, et al. Lumbar spinal stenosis. Clinical features, diagnostic procedures, and results of surgical treatment in 68 patients. Ann Intern Med 1985; 103:271.
- Suri P, Rainville J, Kalichman L, Katz JN. Does this older adult with lower extremity pain have the clinical syndrome of lumbar spinal stenosis? JAMA 2010; 304:2628.
- Katz JN, Dalgas M, Stucki G, et al. Degenerative lumbar spinal stenosis. Diagnostic value of the history and physical examination. Arthritis Rheum 1995; 38:1236.
- Atkinson JL, Miller GM, Krauss WE, et al. Clinical and radiographic features of dural arteriovenous fistula, a treatable cause of myelopathy. Mayo Clin Proc 2001; 76:1120.
- Goldstein JM, Parks BJ, Mayer PL, et al. Nerve root hypertrophy as the cause of lumbar stenosis in chronic inflammatory demyelinating polyradiculoneuropathy. Muscle Nerve 1996; 19:892.
- Diederichs G, Hoffmann J, Klingebiel R. CIDP-induced spinal canal obliteration presenting as lumbar spinal stenosis. Neurology 2007; 68:701.
- Iskandar BJ, Fulmer BB, Hadley MN, Oakes WJ. Congenital tethered spinal cord syndrome in adults. Neurosurg Focus 2001; 10:e7.
- Aufschnaiter K, Fellner F, Wurm G. Surgery in adult onset tethered cord syndrome (ATCS): review of literature on occasion of an exceptional case. Neurosurg Rev 2008; 31:371.
- Ratliff J, Mahoney PS, Kline DG. Tethered cord syndrome in adults. South Med J 1999; 92:1199.
- Saifuddin A. The imaging of lumbar spinal stenosis. Clin Radiol 2000; 55:581.
- Wildermuth S, Zanetti M, Duewell S, et al. Lumbar spine: quantitative and qualitative assessment of positional (upright flexion and extension) MR imaging and myelography. Radiology 1998; 207:391.
- Andreisek G, Hodler J, Steurer J. Uncertainties in the diagnosis of lumbar spinal stenosis. Radiology 2011; 261:681.
- de Schepper EI, Overdevest GM, Suri P, et al. Diagnosis of lumbar spinal stenosis: an updated systematic review of the accuracy of diagnostic tests. Spine (Phila Pa 1976) 2013; 38:E469.
- Lurie JD, Tosteson AN, Tosteson TD, et al. Reliability of readings of magnetic resonance imaging features of lumbar spinal stenosis. Spine (Phila Pa 1976) 2008; 33:1605.
- Schizas C, Theumann N, Burn A, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976) 2010; 35:1919.
- Kanno H, Ozawa H, Koizumi Y, et al. Dynamic change of dural sac cross-sectional area in axial loaded magnetic resonance imaging correlates with the severity of clinical symptoms in patients with lumbar spinal canal stenosis. Spine (Phila Pa 1976) 2012; 37:207.
- Macedo LG, Wang Y, Battié MC. The sedimentation sign for differential diagnosis of lumbar spinal stenosis. Spine (Phila Pa 1976) 2013; 38:827.
- Jensen MC, Brant-Zawadzki MN, Obuchowski N, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994; 331:69.
- Boden SD, Davis DO, Dina TS, et al. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 1990; 72:403.
- Denard PJ, Holton KF, Miller J, et al. Lumbar spondylolisthesis among elderly men: prevalence, correlates, and progression. Spine (Phila Pa 1976) 2010; 35:1072.
- Adamova B, Vohanka S, Dusek L. Differential diagnostics in patients with mild lumbar spinal stenosis: the contributions and limits of various tests. Eur Spine J 2003; 12:190.
- Levin, KH. Radiculopathy. In: Comprehensive Clinical Neurophysiology, Levin, KH, Lüders, HO (Eds). New York, WB Saunders 2000. p.627.
- Tsao BE, Levin KH, Bodner RA. Comparison of surgical and electrodiagnostic findings in single root lumbosacral radiculopathies. Muscle Nerve 2003; 27:60.
- Dyck P, Doyle JB Jr. "Bicycle test" of van Gelderen in diagnosis of intermittent cauda equina compression syndrome. Case report. J Neurosurg 1977; 46:667.
- Deen HG Jr, Zimmerman RS, Lyons MK, et al. Test-retest reproducibility of the exercise treadmill examination in lumbar spinal stenosis. Mayo Clin Proc 2000; 75:1002.
- Deen HG Jr, Zimmerman RS, Lyons MK, et al. Measurement of exercise tolerance on the treadmill in patients with symptomatic lumbar spinal stenosis: a useful indicator of functional status and surgical outcome. J Neurosurg 1995; 83:27.