0
Selected Instructional Course Lecture   |    
Nonsurgical and Surgical Management of Lumbar Spinal Stenosis
Philip S. Yuan, MD1; Todd J. Albert, MD2
1 834 Chestnut Street, Apartment 1419, Philadelphia, PA 19107
2 Department of Orthopaedic Surgery, The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107. E-mail address: tjsurg@aol.com
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in February 2005 in Instructional Course Lectures, Volume 54. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).
An Instructional Course Lecture, American Academy of Orthopaedic Surgeons

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Oct 01;86(10):2319-2330
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Extract

The pain and disability associated with lumbar spinal stenosis can interfere with patients' lifestyles, leading them to seek medical attention. Typical symptoms of spinal stenosis (neurogenic claudication) include pain, numbness, and paresthesias in the posterolateral aspects of the thighs and legs. These symptoms usually radiate distally and are aggravated by prolonged walking or standing. Activities in which the lumbar spine is in flexion, such as walking uphill, leaning forward on a walker or shopping cart, or riding a bicycle, are usually better tolerated by patients with neurogenic claudication. It is crucial to distinguish between neurogenic and vascular claudication when establishing the diagnosis of spinal stenosis1. Claudication of vascular etiology is usually associated with calf pain, which may extend proximally. In peripheral vascular disease, lower-extremity pulses are diminished and the symptoms are aggravated by activity in any position and are relieved by rest in any position. Only after a clear diagnosis of neurogenic claudication has been made and a vascular etiology has been ruled out should treatment of spinal stenosis commence. Treatment options for lowback pain and neurogenic claudication related to lumbar spinal stenosis include nonoperative modalities, surgical decompression alone, or surgical decompression and fusion with or without instrumentation. The treatment approach is guided by the severity and duration of the symptoms, the type and extent of the stenosis, any associated instability or deformity, the degree of disc degeneration, and the presence of coexisting medical conditions.
Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    01/22/2014
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    03/05/2014
    Oklahoma - The University of Oklahoma
    11/15/2013
    Louisiana - Ochsner Health System
    05/03/2012
    California - UCLA/OH Department of Orthopaedic Surgery