Lumbar spinal stenosis. Clinical and radiologic features.
STUDY DESIGN: A prospective, randomized study of patients with symptomatic lumbar spinal stenosis. OBJECTIVES: Evaluation of clinical and radiologic characteristics and relationship. SUMMARY OF BACKGROUND DATA: The diagnosis of lumbar spinal stenosis is frequently used and represents a wide variety of patients with more or less well-defined spinal disorders. METHODS: One hundred patients who met inclusion criteria were consecutively selected from a neurology department and examined clinically and radiologically with plain radiography, myelography, and computed tomographic imaging. RESULTS: Duration of complaints was long, and multilevel, bilateral afflictions were common. The dominanting symptoms were sciatica, neurogenic claudication, and low back pain. The clinical findings were modest. Narrowness in the spinal canal was demonstrated radiologically with signs of compression on nerve roots, centrally and/or laterally. The radiologic findings were more extensive than expected from the clinical symptoms and signs. In most patients the sagittal diameter of the spinal canal increased on flexion and decreased on extension of the spine. An exception was demonstrated in 33 patients where extension increased the diameter, usually at one level. Radiologic subgroups of stenosis were found, but their clinical relationship could hardly be identified. No definite association between the degree of narrowing and clinical symptoms was found. CONCLUSIONS: A clinical picture is demonstrated in 100 patients with symptomatic lumbar spinal stenosis. Different types of stenosis are found radiologically, but their clinical relationships are not identified. The radiologic changes were more extensive than expected from the clinical picture, and the degree of narrowing did not correspond to the degree of clinical affliction.