Lumbar spinal stenosis: Imaging and non-operative management

Lumbar spinal stenosis (LSS) is a common disorder of the spine. It may be classified etiologically, anatomically, and by severity. Radiographic imaging is an integral adjunct to history and physical examination in the successful diagnosis and treatment of the disorder. MRI is the study of choice; however, patient comorbidities and other factors may necessitate use of other imaging modalities, such as CT scan, myelography, radiographs, and dynamic CT or MRI. There are no generally accepted diagnostic criteria on radiologic studies for LSS, but specific measurement criteria commonly used to diagnose the disorder are reviewed. Common findings associated with LSS on each of the imaging modalities are also reviewed. The natural history of LSS demonstrates that roughly 1/3 of patients will improve, 1/3 of patients will experience no significant changes in symptoms type or severity, and 1/3 of patients will experience exacerbation of symptoms requiring surgical treatment. Several non-operative modalities are reviewed including the following: pharmacologic, epidural steroid injections, physical therapy programs, bracing, and chiropractic. Non-operative modalities by and large are unsuccessful in altering the natural history; however, a 3–6 month course of non-operative treatment is recommended prior to proceeding to surgical management. Careful patient selection is critical for both operatively and non-operatively managed patients.