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Table of Contents    
COMMENTARY
Year : 2016  |  Volume : 64  |  Issue : 4  |  Page : 684-685

Lumbar canal stenosis: Clinical, radiological and functional outcome


Department of Neurosurgery, Fortis Escorts Hospital, Jaipur, Rajasthan, India

Date of Web Publication5-Jul-2016

Correspondence Address:
Hemant Bhartiya
Department of Neurosurgery, Fortis Escorts Hospital, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.185384

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How to cite this article:
Bhartiya H. Lumbar canal stenosis: Clinical, radiological and functional outcome. Neurol India 2016;64:684-5

How to cite this URL:
Bhartiya H. Lumbar canal stenosis: Clinical, radiological and functional outcome. Neurol India [serial online] 2016 [cited 2019 Dec 6];64:684-5. Available from: http://www.neurologyindia.com/text.asp?2016/64/4/684/185384


Lumbar canal stenosis (LCS) has been defined as narrowing of the canal diameter with age, leading to degenerative bony and soft tissue changes which may also be associated with listhesis. The most common presentation of this entity is neurogenic claudication, back pain, leg pain and paresthesia, which may be associated with neurological deficit [motor weakness and sphincteric involvement] especially on dynamic testing. Neurological claudication is defined as a poorly localized pain, paresthesia and cramps of one or both lower extremities of neurological origin which occurs on walking and is relieved on taking rest.[1]

The assessment of outcome depends not only on the patient's clinical and radiological findings but also on his mental status and environment, as well as on his/her and the family's expectations.[2] In routine practice, the history of pain and numbness is recorded and walking ability is judged by the distance the patient is able to walk before he has to sit down or at which he/she develops severe numbness or weakness in the legs, or saddle anesthesia. The surgical outcome is also assessed based on all these criteria. There are various methods which have been described and internationally accepted for the clinical and radiological evaluation of patients, which include Treadmill Test, Visual Analog Scale [VAS], Oswestry Disability Index [ODI], SF36 score, Japanese Orthopedic Association Score [JOAS] and Cross Sectional Area [CSA] of the lumbar canal.[3]

Prasad et al., in their study of patients suffering from degenerative lumbar canal stenosis, where clinical, radiological and functional evaluation of patients undergoing surgical treatment was carried out, have taken into consideration all these parameters for assessment in their 48 recruited cases. They have analyzed the VAS and the ODI score for back pain and leg pain with a good surgical outcome, treadmill test for neurogenic claudication by the first symptom time [FST] by measuring the maximum walking distance [MWD] and the maximum walking time [MWT].[4] Radiologically, CSA was measured pre- and postoperatively. The JOA score was assessed for the overall recovery grades. The advantages of various scores mentioned above and both the generic (SF-36) and disease-specific health status index [ODI] have been recommended in the literature for clinical evaluation and for assessing the surgical outcome.[5] The recovery shown in leg and back pain by the present author is in consonance with the other published series but the incidence of motor deficits (79.16%) reported seems to be high and the results are variable when compared with the other series.[6] This study is unique as Prasad et al., have analyzed most of the available assessment scores, tests and criteria. Degenerative lumbar canal stenosis is usually observed in the fifth or sixth decade of life but the present study has also included patients in a unique younger age group (18-65 years).

Management of degenerative LCS varies from conservative treatment to surgical intervention. We feel that a fair trial of conservative management should be given unless patient has progressive neurological deficits or has developed sphincteric symptoms. The goal of surgery is to improve the walking distance and to relieve pain. Surgical options, varying from a simple decompression, decompression with fusion, or decompression with fusion and instrumentation should be individualized considering the patient's age, cardiac status, general condition, family background, profession and financial constraints as well as whether or not the LCS is associated with spondylolisthesis.

Some people may have severe radiological changes but with very few clinical symptoms and others may have significant clinical symptomatology without having significant radiological changes. The patient's selection for surgical management has to be very carefully done. A multicentric trial is required in India for the evaluation of surgical management.



 
  References Top

1.
Porter RW. Pathophysiology of Neurogenic Classification. In: Whesel SW, Weinstein JN, Herkowitz H, Dvorak J, Bell G. editors. The Lumbar Spine. Philadelphia (PA): WB. Saunders: 1996. p. 717-23.  Back to cited text no. 1
    
2.
Fritz JM, Delitto A, Weleh WC, Erhald RE. Review article of current concepts in evaluation management and outcome measurements. Article Phys Med Rehablic 1998;79:700-8.  Back to cited text no. 2
    
3.
Schonstrom N, Boleander NF, Spengler DM. The pathomorphology of spinal stenosis as seen on CT Scans of lumbar spine. Spine 1985;10:806-11.  Back to cited text no. 3
    
4.
Deen HG, Zimmerman RS, Lyons MK, McPhee MC Verheidje JL, Lemens SM, et al. Measurement of exercise tolerance on the treadmill in patients with symptomatic lumbar spinal stenosis: A useful indicator of functional status and surgical outcome. J Neurosurg 1995;83:27-30.  Back to cited text no. 4
    
5.
Deyo RA. Andersson G. Bombardier C, Cherkin DC, Keller RB. Lee CK, et al. Outcome measures for studying patients with low back pain. Spine 1994:19:(Suppl) 2032S-2036S.  Back to cited text no. 5
    
6.
Nath R, Middha S, Gupta AK, Nath R. Functional outcome of surgical management of degenerative lumbar canal stenosis. Indian J Orthop 2012;46:286.  Back to cited text no. 6
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