Spinal Stenosis

Overview

Spinal stenosis is one of the most common conditions in the elderly. It is defined as a narrowing of the spinal canal. The term stenosis is derived from the Greek word for narrow, which is "stenos." The first description of this condition is attributed to Antoine Portal in 1803. Verbiest is credited with coining the term spinal stenosis and the associated narrowing of the spinal canal as its potential cause. Kirkaldy-Willis subsequently described the degenerative cascade in the lumbar spine as the cause for the altered anatomy and pathophysiology in spinal stenosis.

Narrowing in the spine can occur in the central canal, lateral recess, or foramen, leading to compression of the neural elements in those locations. The symptoms produced vary by the location of the neural compression. Neural compression in the central canal leads to the commonly seen clinical presentation of low back pain radiating into bilateral legs. Patients typically also describe heaviness and weakness in their legs that worsens with ambulation and improves with leaning forward or resting. Degeneration of the spine with aging leads to alteration in the anatomy causing gradually progressive narrowing of the spinal canal.

The term spinal stenosis refers to an anatomic diagnosis that increases with age and can occur in asymptomatic individuals. The exact reason for why some with this condition have debilitating symptoms while others have no symptoms is not well understood. These differences in presentation may be related to the different abilities of individuals to compensate for the anatomic changes that have occurred. When symptoms do present, they usually occur on the basis of the location of neural compression. Patients with central canal stenosis typically present with neurogenic claudication, whereas those with lateral recess and foraminal stenosis present with radicular pain. Patients with significant symptoms that do not respond to conservative treatment often elect surgical treatment. In fact, in adults older than 65, spinal stenosis is the most common reason to undergo lumbar spine surgery.