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Outcomes for lumbar stenosis.

R L Swezey1

  • 1Arthritis and Back Pain Center and Osteoporosis Prevention and Treatment Center, Inc., Swezey Institute, Santa Monica, California.

Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases
|December 17, 2008
PubMed
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Most patients with lumbar spinal stenosis and neurogenic claudication stabilize or improve without surgery. Surgical laminectomy offers relief for those with severe, persistent symptoms.

Area of Science:

  • Neurosurgery
  • Orthopedics
  • Physical Medicine and Rehabilitation

Background:

  • Lumbar spinal stenosis (LSS) with neurogenic claudication presents a significant challenge in managing chronic lower back and leg pain.
  • Understanding the natural history and treatment outcomes is crucial for guiding patient care.

Purpose of the Study:

  • To document the long-term natural history and outcomes of lumbar spinal stenosis in patients experiencing neurogenic claudication.
  • To evaluate the effectiveness of conservative treatments and surgical intervention for LSS.

Main Methods:

  • A cohort of 47 patients initially evaluated for LSS 5 years prior were contacted via telephone interview.
  • Thirty-one of these patients underwent re-examination to assess symptom duration, severity, and treatment response.

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  • Outcomes were analyzed for nonsurgical management, intermittent traction, epidural corticosteroid injections, and laminectomy.

    • Main Results:

    • 43% of nonsurgically treated patients showed improvement, while 30% remained unchanged.
    • Intermittent traction improved walking tolerance and reduced back pain in 7 of 11 patients.
    • Epidural corticosteroid injections improved walking tolerance in 8 of 13 patients.
    • Patients with persistent or worsening symptoms found relief after laminectomy.

    Conclusions:

    • The majority of patients with symptomatic lumbar spinal stenosis experience stabilization or improvement without surgical intervention.
    • Nonsurgical treatments like traction and epidural injections can offer symptomatic relief for neurogenic claudication.
    • Laminectomy remains an effective option for patients with intolerable symptoms unresponsive to conservative care.