Degenerative Lumbar

Spinal Stenosis*

Dr. Rendra Leonas

Sub.Div orthopaedic Moh, Hoesin General Hospital/ Faculty
Medicine Sriwijaya University
DEFINITION
 narrowing of the spinal canal that produces
compression of the neural elements before their exit
from the neural foramen.

CLASSIFICATION
Etiology
 congenital or developmental stenosis
 from acquired or degenerative spinal stenosis
Anatomical classification

 pedicle level, the intermediate (vertebral body) level,

and the disc level

 central zone, the lateral-recess zone, and the pedicle

zone
 Fig. 1 Anatomical grid pattern used to evaluate lumbar spinal stenosis.

SPIVAK J M J Bone Joint Surg Am 1998;80:1053-66

©1998 by The Journal of Bone and Joint Surgery, Inc.

 CLINICAL PRESENTATION
 bilateral neurogenic claudication
 intermittent pain radiating to the thigh or the leg, or both, that
is worse with prolonged standing, activity, or lumbar
extension
 relieved by sitting, lying down, or lumbar flexion
 intermittent burning, numbness, heaviness, or weakness
radiating to the lower extremity
 In the study by Jönsson and Strömqvist, patients with lateral
stenosis were less limited in terms of walking ability but had
a greater prevalence of pain at rest and at nigh
 CLINICAL PRESENTATION
 Back pain also is common in patients who have
degenerative lumbar spinal stenosis and is more likely to be
related to degenerative disc disease than to compression of
a nerve.
 walk with a stooped forward gait and even maintain this
posture while standing. Characteristically, the pain is
exacerbated with lumbar extension and is relieved with
lumbar flexion.
 Disturbances in sensory function (such as light touch, two-
point discrimination, and proprioception) are more common
in patients who have degenerative lumbar spinal stenosis.