LUMBAR SPINAL STENOSIS - A REVIEW OF CURRENT CONCEPTS IN EVALUATION, MANAGEMENT, AND OUTCOME MEASUREMENTS

The purpose of this review is to present current information from the literature regarding the pathoanatomy, clinical presentation, differen tial diagnosis, treatment, and outcome assessment methods for patients with lumbar spinal stenosis. Lumbar spinal stenosis is a frequently e ncountered condition, particularly in the elderly. Treatment requires an accurate diagnosis, but differential diagnosis of lumbar stenosis c an be difficult. The literature to date has focused primarily on surgi cal treatment. The long-term efficacy of surgery has been questioned, and surgical procedures are associated with increased costs and risks of morbidity in an elderly population. A trial of conservative care is recommended in most cases, but there are presently no randomized cont rolled studies in the literature comparing surgical versus conservativ e management, or evaluating the effectiveness of any specific conserva tive treatment approach. The existing literature has further been crit icized for having poorly defined outcome measures. The assessment of t reatment outcomes should be multifactorial, including measures of path oanatomy and impairments, as well as patient-centered measures such as level of disability, patient expectations, and satisfaction. The pres ent level of understanding of lumbar spinal stenosis is deficient in m any areas, including differential diagnosis, treatment, and outcome as sessment. Future research should address these deficits to improve the management of patients with this condition. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physic al Medicine and Rehabilitation.