Lumbar spinal stenosis - Treatment strategies and indications for surgery

Spinal stenosis is defined as a narrowing of the spinal canal, producing symptoms of radiculopathy or claudication, and it is a common finding in an aging or degenerative spine. Dutch surgeon Henk Verbiest first described the clinical syndrome of spinal stenosis in a classic article in 1954 [1]. This article contains a clear description of the typical signs and symptoms, and a clear outline of intermittent claudication of the spine in seven patients. Spinal stenosis was demonstrated in these cases with myelography. With the availability of modern imaging facilities, lumbar spinal stenosis is being increasingly recognized as a cause of low back pain and radiculopathy in elderly patients [2]. Surgical treatment for spinal stenosis has increased in the United States by eightfold between 1979 and 1992, from 7.8 to 61 procedures per 100,000 persons in the 65+ age group [3]. There has been, however, no long-term prospective randomized controlled study to establish the superiority of surgical treatment over natural history of this disease.