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
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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
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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.
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    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.
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