[Degenerative spinal canal stenosis in lumbar spine: clinical view and treatment.]

Radicular leg pain, combined with numbness and intermittent radicular paresis while walking or standing are typical symptoms of a narrow spinal canal of the lumbar spine. Medical history and lumbar myelogram are usually sufficient to localize the source of pain. We prefer the myelogram to CT-scan or MRI because it gives a longitudinal view of the whole lumbar spine, is easy to read and is also possible in the presence of a scoliotic deformity or claustrophobia. Between 1987 and 1993, 76 patients with symptomatic lumbar spinal stenosis were treated operatively by the same surgeon. Results are available for 74 patients. In all patiens, a decompression was performed, a fusion was performed in 64 patients. The follow-up ranges from 1 to 5.7 years (average 2.7 years). 59 patients (80 %) were happy with the result and would like to be operated again in the same conditions. 8 of the 15 unhappy patients had, objectively, a good result but were unsatisfied for other reasons. Our results show, that operative treatment of the lumbar spinal stenosis is a rewarding task. Decompression usually results in a dramatic decrease of the leg pain and improvement of the walking distance. Advanced age in not a contraindication for this kind of surgery. Decompression combined with fusion results in a longer operative time and greater blood loss and is only indicated in the presence of an instability in a younger patient or massive preoperative back pain. Key words: spinal stenosis, claudication, lumbar spine, decompression, fusion.