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Degenerative Lumbar Spinal Stenosis: Evaluation and Management

Issack, Paul S. MD, PhD; Cunningham, Matthew E. MD, PhD; Pumberger, Matthias MD; Hughes, Alexander P. MD; Cammisa, Frank P. Jr MD

Journal of the American Academy of Orthopaedic Surgeons: August 2012 - Volume 20 - Issue 8 - p 527–535
doi: 10.5435/JAAOS-20-08-527
Review Article

Degenerative lumbar spinal stenosis is caused by mechanical factors and/or biochemical alterations within the intervertebral disk that lead to disk space collapse, facet joint hypertrophy, soft‐tissue infolding, and osteophyte formation, which narrows the space available for the thecal sac and exiting nerve roots. The clinical consequence of this compression is neurogenic claudication and varying degrees of leg and back pain. Degenerative lumbar spinal stenosis is a major cause of pain and impaired quality of life in the elderly. The natural history of this condition varies; however, it has not been shown to worsen progressively. Nonsurgical management consists of nonsteroidal anti‐inflammatory drugs, physical therapy, and epidural steroid injections. If nonsurgical management is unsuccessful and neurologic decline persists or progresses, surgical treatment, most commonly laminectomy, is indicated. Recent prospective randomized studies have demonstrated that surgery is superior to nonsurgical management in terms of controlling pain and improving function in patients with lumbar spinal stenosis.

From the Hospital for Special Surgery, New York, NY.

Dr. Hughes or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of NuVasive; serves as a paid consultant to BOSS Medical, Bovie Medical Corporation, Orthovita, and SpineView; and has received research or institutional support from NuVasive. Dr. Cammisa or an immediate family member has received royalties from NuVasive; serves as a paid consultant to Alphatec Spine, Centinel Spine, Disc Motion Technologies, HealthpointCapital Partners, IVY Healthcare Partners, Mazor Surgical Technologies, NuVasive, Orthogem, Orthovita, Paradigm Spine, Spinal Kinetics, Spinal Partners III, and Viscogliosi Brothers; and has stock or stock options held in Alphatec Spine, BI Members, Centinel Spine, Disc Motion Technologies, HealthpointCapital Partners, IVY Healthcare Partners, Mazor Surgical Technologies, NuVasive, Orthovita, Orthopaedic Investment Partners, Paradigm Spine, Small Bone Innovations, Spinal Kinetics, and Viscogliosi Brothers. None of the following authors or any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Issack, Dr. Cunningham, and Dr. Pumberger.

© 2012 by American Academy of Orthopaedic Surgeons
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