The Orthobullets Podcast Foundations | Spine | Lumbar Spinal Stenosis
Aug 29, 2025
Dive into the complexities of lumbar spinal stenosis, exploring its causes and the critical role of MRI in diagnosis. Learn about the significant anatomical factors contributing to the condition and effective treatment strategies, with a strong emphasis on non-operative management. Discover the nuances of neurogenic claudication, including how patient positioning can affect symptoms. Engaging clinical scenarios highlight the importance of differentiating this condition from others. Misconceptions related to spinal treatments are also addressed.
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Definition And Key Diagnostic Tool
- Lumbar spinal stenosis is degenerative narrowing of the lumbar canal from bony or soft-tissue causes.
- MRI is the diagnostic modality of choice and guides management decisions.
Common Levels And Multifactored Mechanism
- Stenosis most commonly affects L4–L5 and arises from facet osteophytes, spondylolisthesis, disc bulges, ligamentum flavum hypertrophy, or facet cysts.
- Both bony and soft-tissue structures contribute, so imaging must assess all elements.
Anatomic Clues To Symptoms
- Central herniations affect the traversing root while far-lateral herniations affect the exiting root, and facets become more coronal inferiorly.
- Neurologic exam is often normal and symptoms may only appear with extension or ambulation.