Lumbar Spinal Stenosis
Lumbar spinal stenosis is narrowing of the spinal canal or nerve-root canals in the lower back. It most often develops from degenerative (age-related) causes and is characterized by leg pain that worsens with walking and eases with rest (neurogenic claudication).
最終更新: 2026-06-06
Definition
Lumbar spinal stenosis is narrowing of the central canal, lateral recess or foramen in the lumbar spine, leaving insufficient room for the neural structures passing through. Narrowing may arise from bone, disc and ligament (notably thickening of the ligamentum flavum). Stenosis may involve a single or multiple levels.
Causes and Risk Factors
The most common cause is age-related degenerative change: loss of disc height, facet joint hypertrophy, ligamentum flavum thickening and osteophyte formation. Less commonly, a congenitally narrow canal, spondylolisthesis or changes from prior surgery contribute. Advanced age is the principal risk factor.
Symptoms
The characteristic feature is neurogenic claudication: leg pain, numbness and weakness brought on by walking or standing and relieved by forward flexion or sitting. Patients often report relief while leaning on a shopping cart (flexed posture). Advanced cases may show balance problems and, rarely, bladder symptoms.
Diagnosis
Diagnosis is supported by history and neurological examination; distinguishing neurogenic from vascular claudication is important. Magnetic resonance imaging (MRI) best demonstrates canal narrowing and neural compression. Computed tomography (CT) is complementary for bony stenosis and in patients with prior surgery.
Treatment
Initial treatment is conservative: exercise and physical therapy, pain management and, in selected cases, epidural injections. Decompression surgery (laminectomy/laminotomy), with fusion when needed, is considered for marked walking limitation, progressive neurological deficit or severely disabling symptoms unresponsive to conservative care.
Prognosis
Many patients remain stable with conservative treatment; appropriately selected surgical patients can expect improvement in walking distance and leg symptoms. Because the condition develops on a degenerative background, follow-up is important; outcomes vary individually.
参考文献
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1328-1348.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011.
- Weinstein JN, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis (SPORT). N Engl J Med. 2008.
本項目は一般的な情報提供を目的としており、医師の診察に代わるものではありません。診断と治療の判断は個々の状況によります。