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Sager Hanna MB, BCh, BAO, 1 Perry Dhaliwal MD, MPH, FRCSC,2

1Section of Neurosurgery and Section of Orthopedic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba.
2Assistant Professor of Neurosurgery, Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba.

CLINICAL TOOLS

Abstract: Lumbar canal stenosis is an anatomical term used to describe narrowing of the spinal canal either congenitally or from age-related degenerative changes. It refers to a structural finding that may or may not be symptomatic. A decrease in canal diameter can lead to compression of the neural components, causing a constellation of symptoms. Family physicians should familiarize themselves with the various presentations of canal narrowing and the available diagnostic and treatment options.
Key Words: lumbar spinal stenosis, neurogenic claudication, back pain, radiculopathy.

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1. Lumbar spinal stenosis is commonly caused by age-related degenerative changes involving the intervertebral discs, ligamentum flavum and facet joints.
2. Patients with lumbar spinal stenosis may present with neurogenic claudication or radiculopathy.
3. The primary care provider needs to distinguish between symptomatic lumbar spinal stenosis and other common mimics.
4. Surgical treatment is principally decompression of the neural elements with the possible addition of fusion of the affected levels.
1. Degenerative changes in the lumbar spine can lead to various symptoms such as low back pain, lumbar radiculopathy, neurogenic claudication, and cauda equina syndrome.
2. Imaging of the lumbar spine should be ordered when there is a high clinical suspicion of lumbar spinal canal stenosis based on the history and physical examination.
3. Initial management of patients presenting with lumbar canal stenosis involves non-operative modalities like pharmacological therapy, physiotherapy, lifestyle modifications, patient education and image-guided injections.
4. Surgical decompression for symptomatic lumbar spinal stenosis, with or without fusion, is generally indicated when symptoms significantly interfere with daily activity and non-operative treatment has failed after 3-6 months.
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Related Terms: Back Health, lumbar spinal stenosis, neurogenic claudication, back pain, radiculopathy