Lumbar Spinal Stenosis Treatment Algorithm – Delphi Consensus
Lumbar spinal stenosis (LSS) is a common condition affecting older adults, which is treated with a variety of non-surgical and surgical interventions. Despite up to 35% of patients having poor satisfaction with surgical outcomes at one-year follow-up and the lack of sustained benefits of surgery at 2-4 years’ follow-up, there have been an increasing number of LSS surgeries performed. Aside from urgent cases involving cauda equina symptoms or significant neurological deficits, surgery is generally regarded as an elective procedure for patients who fail to receive satisfactory outcomes with non-surgical care.
Non-surgical treatment options are frequently used in the management of LSS, but there is limited research to support their use. In addition, there is uncertainty regarding which patients are likely to respond to specific treatments, posing a challenge to both patients and clinicians. Therefore, this study attempted to reach international expert consensus on an acceptable treatment algorithm to guide clinical practice for those seeing LSS patients.
The participants in this Delphi study considered three phenotypes of LSS, which cab be summarized as follows:
Phenotype A – neurogenic claudication pain symptoms: described as widespread lower extremity pain aggravated during walking, with symptoms including aching, cramping, pain or burning, most commonly impacting both legs. Standing and walking aggravate their symptoms with sitting and forward flexion relieving. These symptoms are generally considered to be due to central canal stenosis in the lumbar spine.
Phenotype B – neurogenic claudicant sensory/balance symptoms: include tingling, paresthesia, numbness and weakness in the lower extremity, which are usually bilateral and can include balance problems. These symptoms are precipitated by standing and walking and generally due to central canal stenosis.Phenotype C – radicular unilateral leg pain symptoms: predominantly affecting one lower extremity and considered to be due to direct nerve root compression as a result of lateral recess canal stenosis or foraminal stenosis in the lumbar spine. These symptoms may follow a specific dermatomal pattern and is aggravated by standing and walking but also may be present at other times. Since there may be inflammation of the nerve root, symptoms are less influenced by a change in posture and may be experienced at rest, when sitting or at night in bed.
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RESEARCH REVIEW: “Lumbar Spinal Stenosis Treatment Algorithm”
This paper was published in BMC Musculoskeletal Disorders (2022) and this Review is posted in Lumbar Spinal Stenosis, Geriatrics and the 2023 Archive.