[Symptomatic lumbar spinal stenosis: diagnostic evaluation and therapeutic strategies]

Lumbar spinal stenosis is a common problem in daily routine practice. In the vast majority of cases stenosis is caused by degenerative changes of the lumbar spine with neurogenic claudication being the typical symptom. This is defined as sciatic pain and discomfort which deteriorates during walking and standing, leading to progressive neurological deficits. The diagnostic evaluation is based on the typical history of the patient and the clinical examination followed by magnetic resonance imaging (MRI) and flexion-extension X-ray films as the most sensitive diagnostic tool. When clinical symptoms are mild, conservative treatment might be an option but in severely disabled patients and/or in cases of relevant neurological deficits surgical decompression, in special cases combined with instrumentation should be favoured when clinical and radiological findings match. In these cases an improvement of the clinical symptoms can be achieved in up to 90% of the patients.