Lumbar spinal stenosis in the elderly: an overview

  • Marek Szpalski
  • Robert Gunzburg
Conference paper


Lumbar spinal stenosis is a common condition in elderly patients and also one of the most common reasons to perform spinal surgery at an advanced age. Disc degeneration, facet degeneration and hypertrophy, and ligamentum flavum hypertrophy and calcification usually participate in the genesis of a stenotic condition in the elderly. These changes can lead to symptoms by themselves or decompensate a preexisting narrow canal. Although some lesions are more central or more lateral, this classic dichotomy is less present in the elderly patient, in whom the degenerative process usually encroaches both central and lateral pathways. Some less common causes of lumbar spinal stenosis are found in the aging subject, such as Paget’s disease. However, it must be stressed that so-called stenotic images (sometimes severe) are present on imaging studies in a great number of symptom-free individuals, and that the relationship between degenerative lesions, importance of abnormal images, and complaints is still unclear. Lumbar stenosis is a very common reason for decompressive surgery and/or fusion. Various conditions can lead to a narrowing of the neural pathways and differential diagnosis with vascular troubles, also common in the elderly, can be challenging. The investigation of stenotic symptoms should be extremely careful and thorough and include a choice of technical examinations including vascular investigations. This is of utmost importance, especially if a surgical sanction is considered to avoid disappointing results.


Lumbar spinal stenosis Elderly Paget’s disease 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Adamova B, Vohanka S, Dusek L (2003) Differential diagnosis in patients with mild lumbar spinal stenosis: the contributions and limits of various tests. Eur Spine J 12:190–196PubMedGoogle Scholar
  2. 2.
    Berney J (1994) Epidemiology of narrow spinal canal. Neurochirurgie 40:174–178PubMedGoogle Scholar
  3. 3.
    Boden S, Davies DO, Dina TS et al (1990) Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects. A positive investigation. J Bone Joint Surg Am 72:403–408Google Scholar
  4. 4.
    Borenstein DG, O’Mara JW Jr, Boden SD et al (2001) The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects: a seven-year follow-up study. J Bone Joint Surg Am 83:1306–1311PubMedGoogle Scholar
  5. 5.
    Douglas DL, Dugworth T, Kanis JA et al (1981) Spinal cord dysfunction in Paget’s disease of bone. Has medical treatment a vascular basis. J Bone Joint Surg Br 63:495–503Google Scholar
  6. 6.
    Gagne F (1995) Intraligamentary amyloid deposits in spinal canal stenosis. Can J Neurol Sci 22:164–167PubMedGoogle Scholar
  7. 7.
    Gill GG, Manning JG, White HL (1955) Surgical treatment of spondylolisthesis without spine fusion. J Bone Joint Surg Am 37:493–520PubMedGoogle Scholar
  8. 8.
    Gunzburg R, Keller TS, Szpalski M et al (2003) Clinical and psychofunctional measures of conservative decompression surgery for lumbar spinal stenosis: a prospective cohort study. Eur Spine J 12:197–204CrossRefPubMedGoogle Scholar
  9. 9.
    Gutwirth P (2000) Distinguishing vascular disease from lumbar spinal stenosis. In: Gunzburg R, Szpalski M (eds) Lumbar spinal stenosis. Lippicott Williams & Wilkins, Philadelphia, pp 115–124Google Scholar
  10. 10.
    Herno A, Airaksinen O, Saari T (1994) Computed tomography after laminectomy for lumbar spinal stenosis. Spine 19:1975–1978PubMedGoogle Scholar
  11. 11.
    Herno A, Saari T, Suomalainen O et al (1999) The degree of decompressive relief and its relation to clinical outcome in patients undergoing surgery for lumbar spinal stenosis. Spine 24:1010–1014CrossRefPubMedGoogle Scholar
  12. 12.
    Kanis JA (1991) Pathophysiology and treatment of Paget disease of bone. Dunnitz, LondonGoogle Scholar
  13. 13.
    Kloc W, Wasilewski W, Imielinski BL, et al (1998) Epidural gas aggregation in the course of gaseous degeneration of lumbar intervertebral disk as a cause foot paresis. Neurol Neurochir Pol 32:699–704PubMedGoogle Scholar
  14. 14.
    Lane WA (1893) Case of spondylolisthesis associated with progressive paraplegia: laminectomy. Lancet I:991Google Scholar
  15. 15.
    Marcelli C, Perennou D, Cyteval C et al (1996) Amyloidosis related cauda equina compression in long term hemodialysis patients. Three case reports. Spine 21:381–385CrossRefPubMedGoogle Scholar
  16. 16.
    Martinelli TA, Wiesel SW (1992) Epidemiology of spinal stenosis. Instr Course Lect 41:179–181PubMedGoogle Scholar
  17. 17.
    McDonald EB, Porter R, Hibbert C et al (1984) The relationship between spinal canal diameter and back pain in coal miners. Ultrasonic measurement as a screening test. J Occup Med 26:23–28PubMedGoogle Scholar
  18. 18.
    McNab I (1950) Spondylolisthesis with an intact neural arch: the so-called pseudo-spondylolisthesis. J Bone Joint Surg Br 32:325–333PubMedGoogle Scholar
  19. 19.
    Miller JAA, Schmatz C, Schultz AB (1988) Lumbar disc degeneration: correlation with age, sex and spine levels in 600 autopsy specimens. Spine 13:173–178PubMedGoogle Scholar
  20. 20.
    Miyamoto S, Takaoka K, Yonenobu K et al (1992) Ossification of the ligamentum flavum induced by bone morphogenic protein. J Bone Joint Surg Br 74:279–283PubMedGoogle Scholar
  21. 21.
    Newman PH (1963) The aetiology of spondylolisthsesis. J Bone Joint Surg Br 45:39Google Scholar
  22. 22.
    Porter RW (2000) Vascular compression theory. In: Gunzburg R, Szpalski M (eds) Lumbar spinal stenosis. Lippincott Williams & Wilkins, Philadelphia, pp 159–162Google Scholar
  23. 23.
    Porter RW, Ward D (1992) cauda equina dysfunction: the significance of multiple level pathology. Spine 17:9–15PubMedGoogle Scholar
  24. 24.
    Postacchini F Gumina S, Cinotti G et al (1994) Ligamenta flava in lumbar disc herniation and spinal stenosis. Light and electron microscopic morphology. Spine 19:917–922PubMedGoogle Scholar
  25. 25.
    Sasaki K (1995) Magnetic resonance imaging findings of the lumbar nerve root pathway in patients over 50 years old. Eur Spine J 4:71–76CrossRefPubMedGoogle Scholar
  26. 26.
    Schmidek HH (1977) Neurologic and neurosurgical sequalae of Paget disease of bone. Clin Orthop 127:70–77PubMedGoogle Scholar
  27. 27.
    Schonstron NR, Hansson GH (1991) Thickness of the human ligamentum flavum as a function of load: an in vitro experimental study. Clin Biomech 6:19–24CrossRefGoogle Scholar
  28. 28.
    Schrader P, Grob D, Rahn BA (1993) Histological changes in the ligamentum flavum in patients with spinal stenosis. Orthopade 22:223–226PubMedGoogle Scholar
  29. 29.
    Schrader PK, Grob D, Rahm BA et al (1999) Histology of the ligamentum flavum in patients with degenerative lumbar spinal stenosis. Eur Spine J 8:323–328CrossRefPubMedGoogle Scholar
  30. 30.
    Szpalski M, Michel F, Hayez JP (1996) Determination of trunk motion patterns associated with permanent or transient stenosis of the lumbar spine. Eur Spine J 5:332–337CrossRefPubMedGoogle Scholar
  31. 31.
    Szpalski M, Gunzburg R (1998) The role of surgery in the management of low back pain. Baillieres Clin Rheumatol 12:141–159PubMedGoogle Scholar
  32. 32.
    Verbiest H (1954) A radicular symptom from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg Br 36:230–237PubMedGoogle Scholar
  33. 33.
    Videman T, Battié MC (1999) The influence of occupation on lumbar degeneration. Spine 24:1164–1168CrossRefPubMedGoogle Scholar
  34. 34.
    Videman T, Nurminen M, Troup JDG (1990) Lumbar spinal pathology in cadaveric material in relation to history of back pain, occupation and physical loading. Spine 15:728–740PubMedGoogle Scholar
  35. 35.
    Wiltse LL, Rothman SLG (1996) Lumbar and lumbosacral spondylolisthesis. In: Wiesel SW, Weinstein JN, Herkowitz et al (eds) The lumbar spin. Saunders, Philadelphia, pp 621–654Google Scholar
  36. 36.
    Wong HK, Bose K (1992) Spinal stenosis-Result of surgical treatment. J Westn Pac Orthopaedic Assoc 29:37–41Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2005

Authors and Affiliations

  • Marek Szpalski
    • 1
  • Robert Gunzburg
    • 2
  1. 1.Department of OrthopedicsHôpitaux Iris Sud-Molière LongchampBrusselsBelgium
  2. 2.Department of OrthopedicsEeuwfeestkliniekAntwerpBelgium

Personalised recommendations