Conservative management of lumbar spinal stenosis. Identifying patients likely to do well without surgery

Lumbar spinal stenosis is a painful condition that often leads to irreversible neurologic damage and functional disability. Thus, early diagnosis and management are important. Conservative therapy, which is appropriate for many patients, minimizes invasive intervention and decreases the risks of morbidity. As more people live to older ages, the incidence of lumbar spinal stenosis will likely increase. If results of a thorough history and physical examination suggest the disorder, a course of appropriate physical therapy should be started promptly; more expensive tests and treatments are reserved for patients whose pain is refractory to early conservative intervention. However, if pain is severe, if the origin is not clear, or if neurologic deficits quickly become worse, immediate neuroradiologic studies should be considered, including timely EMG. Strong guidance by the primary care physician is of paramount importance because the therapeutic program is lengthy. Additional help from a physiatrist, neurologist, or orthopedic surgeon may be indicated as treatment progresses.