Management of Lumbar Spinal Stenosis through the Use of Translatoric Manipulation and Lumbar Flexion Exercises: A Case Series

Abstract

Lumbar spinal stenosis is a narrowing of the spinal canal or intervertebral foramen that can produce low back pain and leg pain and weakness. Surgical intervention is commonly performed to relieve these symptoms. Symptom reduction and longitudinal management of functional deficits with conservative care is less well documented. The purpose of this case series was to describe the outcomes of a conservative physical therapy program consisting of low- and high-velocity translatoric manipulations of T1-T9 and L1-L3, and two lumbar flexion exercises on 6 subjects diagnosed with lumbar spinal stenosis and neurogenic claudication. A treadmill test was repeated on a weekly basis and at discharge for each patient. All six subjects demonstrated improvements in treadmill walking time prior to the onset of neurogenic claudication (range: 1 min 34 sec to 26 min); in Oswestry Low Back Pain Disability Index scores (range: 7.5% to 64.7%); and in McGill Pain Questionnaire scores (range: 25% to 57%). Five subjects were measured using the Schober technique, and all showed improvement in thoracolumbar flexion mobility. Combined use of translatoric manipulation and spinal flexion exercises may have resulted in improved spinal flexibility, ambulatory abilities, and pain and functional status in six subjects with lumbar spinal stenosis.     

Effectiveness of Conservative Nonpharmacologic Therapies for Pain,Disability, Physical Capacity,and Physical Activity Behavior in Patients With Degenerative Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

ObjectiveTo investigate the effectiveness of conservative nonpharmacologic therapies on pain, disability, physical capacity, and physical activity outcomes in patients with degenerative lumbar spinal stenosis (LSS).Data SourcesSystematic search of MEDLINE, EMBASE, CENTRAL, and PsycINFO from inception to November 4, 2019, without language restrictions.Study SelectionPairs of review authors independently identified randomized controlled trials published in peer-reviewed scientific journals reporting on the effects of rehabilitation interventions on pain intensity (back or leg), disability, symptom severity, physical capacity, physical activity behavior, or adverse events (secondary outcome) in adults with LSS. The search identified 1718 records; data from 21 reports of 19 trials (1432 patients) were included.Data ExtractionReview author pairs independently extracted data and assessed included studies. We assessed risk of bias with the Cochrane tool, and overall study quality with the Grading of Recommendations Assessment, Development and Evaluation classification.Data SynthesisWe pooled data using random-effects meta-analyses; treatment effects were reported as mean differences (MD) and 95% confidence intervals (CI). Directed exercise and manual therapy was superior to self-directed or group exercise for improving short-term walking capacity (MD, 293.3 m; 95% CI, 61.7-524.9 m; low-quality evidence), back pain (MD, –1.1; 95% CI, –1.8 to –0.4; moderate quality evidence), leg pain (MD, –.9; 95% CI, –0.2 to –1.5; moderate-quality evidence), and symptom severity (MD, –0.3; 95% CI, –0.4 to –0.2; low quality evidence). There is very low quality evidence that rehabilitation is no better than surgery at improving intermediate- or long-term disability. Single trials provided conflicting evidence of effectiveness for a variety of therapies.ConclusionsFor patients with LSS, there is low- to moderate-quality evidence that manual therapy with supervised exercises improves short-term walking capacity and results in small improvements in pain and symptom severity compared with self-directed or group exercise. The choice between rehabilitation and surgery for LSS is very uncertain owing to the very low quality of available evidence.     

Usefulness of a cognitive behavioural and rehabilitative approach to enhance long lasting benefit after lumbar spinal stenosis and degenerative spondylolisthesis surgery. A case report

Most spine-surgically treated patients are considered eligible for rehabilitative treatment. Unfortunately, an evidence-based consensus on the best postsurgical conservative treatment is not mentioned. In absence of a shared pathway, physical therapies, exercises, back schools, massages and other manual therapies are sometimes recommended by surgeons and clinicians. Like common low back pain, spinal problems in the postsurgical phase should be reconsidered through a bio-psycho-social model, advocating comprehensive evaluations and broader answers to patient-perceived pain, disability, and quality of life needs. The Authors report the clinical case of a 60-year-old woman, operated for lumbar spinal stenosis (LSS) and L4-L5 degenerative spondylolisthesis, early entered in a Rehabilitation Hospital Unit, undergoing rehabilitative and cognitive behavioural therapy. Physical and psychological evaluation, outcome measures, physical and psychological therapies are here illustrated. The obtained results are encouraging for pain, disability and quality of life, assessing usefulness of a bio-psycho-social approach for spine-operated patients. A randomized controlled trial for rehabilitative and cognitive behavioural postsurgical treatment for patients with lumbar spinal stenosis and degenerative spondylolisthesis is advocated to provide further evidence to approaches and results. Proper outcome measures, correct clinical relevance evaluation and adequate follow-ups are needed.     

mild Procedure for Lumbar Decompression: A Review

Abstract: Lumbar spinal stenosis (LSS) is characterized by narrowing of the spinal canal with impingement of the spinal cord by surrounding tissues of bones. Current management options for LSS include rest, medications, physical therapy, epidural steroid injections, alternative medicine, and surgical decompression. Because each modality of treatment has its own set of limitations, there is a need for a safe, effective, and cost‐saving treatment for LSS. mild is a minimally invasive procedure for treatment of degenerative LSS with ligamentum flavum hypertrophy through percutaneous decompression of the hypertrophic ligamentum flavum. The effect is debulking of tissue that is a contributor to lumbar canal narrowing with minimal trauma to surrounding tissue. This literature review presents a brief review of the pathophysiology, clinical presentation, and current treatment options for LSS and reviews the current literature regarding the efficacy, safety, and cost‐effectiveness of the mild procedure.     

Lumbar spinal stenosis-diagnosis and management of the aging spine

Low back pain and lumbar spinal stenosis (LSS) is an extensive problem in the elderly presenting with pain, disability, fall risk and depression. The incidence of LSS is projected to continue to grow as the population ages. In light of the risks, costs and lack of long-term results associated with surgery, and the positive outcomes in studies utilizing physical therapy interventions for the LSS patient, a non-invasive approach is recommended as a first line of intervention. This Masterclass presents an overview of LSS in terms of clinical examination, diagnosis, and intervention. A focused management approach to the patient with LSS is put forward that emphasizes a defined four-fold approach of patient education, manual physical therapy, mobility and strengthening exercises, and aerobic conditioning.     

Nonsurgical management of patients with lumbar spinal stenosis: a literature review and a case series of three patients managed with physical therapy

This article critically reviews the available literature regarding nonsurgical management for lumbar spinal stenosis (LSS) and presents a case series of three patients managed with manual physical therapy. This case series uses a well-defined, impairment-based, noninvasive, outpatient treatment program for patients with LSS and provides patient-centered, long-term outcome information. The outpatient treatment program focuses on patients' individualized, prioritized impairments identified on initial examination, and emphasizes manual physical therapy techniques targeting each patient's impairments, specific exercises to either reinforce the manual physical therapy treatment or strengthen specific muscles, and a walking program. The results demonstrate that patients with LSS can make significant gains in disability, symptoms, and function in relatively short periods of time and that these gains can be maintained for up to 18 months. Under this physical therapy program, patients experienced significant improvements, and the potential adverse effects of invasive therapies or pharmacologic management strategies, which often are included in other "nonsurgical" treatment programs, were avoided.     

Aims and Objectives of IFOMT Educational Standards

Abstract

The interacting systems of the entire spine make the diagnosis and treatment of lumbar spinal stenosis a difficult and challenging condition for the manual therapist. Not only is the aged population of patients with symptomatic spinal stenosis increasing, so is the number of younger males 30–40 years with a history of untreated sports trauma in their formative teenage years. With advanced knowledge of the condition, sophisticated investigations and skilled manual therapy techniques conservative treatment will often afford the patient great relief from symptoms.     

Long‐Term Results of Percutaneous Lumbar Decompression mild® for Spinal Stenosis

Background: Lumbar spinal stenosis (LSS) generally occurs from a combination of degenerative changes occurring in the lumbar spine. These include hypertrophy of ligamentum flavum, facet joint arthritic changes and bulging of the intervertebral disk. Spinal stenosis leads to compression of the lumbar neural elements (cauda equina), which manifests as low back and leg pain especially on standing and walking known as “neurogenic claudication.” Current treatment options for LSS are varied. Conservative management, including physical therapy with/without epidural steroid injections, may be adequate for mild stenosis. Surgical decompression is reserved for severe cases and results in variable degrees of success. Patients with moderate‐to‐severe LSS having ligamentum flavum hypertrophy as a key contributor are generally inappropriately treated or undertreated. This is due to ineffectiveness of conservative therapy and possibility that major surgical compression might be too aggressive. Percutaneous decompression offers a possible solution for this patient population. Methods: One‐year follow‐up study was conducted at 11 U.S. sites. Study cohort included 58 mild^® percutaneous decompression patients who underwent 170 procedures, the majority treated bilaterally at one or two lumbar levels. Outcome measures included the visual analog scale (VAS), Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and SF‐12v2^® Health Survey. Results: No major mild^® device or procedure‐related complications were reported. One‐year data showed significant reduction of pain as measured by VAS. Improvement in physical functionality, mobility, and disability was significant as measured by ZCQ, SF‐12v2, and ODI. Conclusions: At 1 year this 58‐patient cohort demonstrated continued excellent safety profile of the mild^® procedure and equally important, showed long‐term pain relief and improved functionality.     

Non-Surgical Interventions for Lumbar Spinal Stenosis Leading To Neurogenic Claudication: A Clinical Practice Guideline

Lumbar spinal stenosis (LSS) causing neurogenic claudication (NC) is increasingly common with an aging population and can be associated with significant symptoms and functional limitations. We developed this guideline to present the evidence and provide clinical recommendations on nonsurgical management of patients with LSS causing NC. Using the GRADE approach, a multidisciplinary guidelines panel based recommendations on evidence from a systematic review of randomized controlled trials and systematic reviews published through June 2019, or expert consensus. The literature monitored up to October 2020. Clinical outcomes evaluated included pain, disability, quality of life, and walking capacity. The target audience for this guideline includes all clinicians, and the target patient population includes adults with LSS (congenital and/or acquired, lateral recess or central canal, with or without low back pain, with or without spondylolisthesis) causing NC. The guidelines panel developed 6 recommendations based on randomized controlled trials and 5 others based on professional consensus, summarized in 3 overarching recommendations: (Grade: statements are all conditional/weak recommendations) Recommendation 1. For patients with LSS causing NC, clinicians and patients may initially select multimodal care nonpharmacological therapies with education, advice and lifestyle changes, behavioral change techniques in conjunction with home exercise, manual therapy, and/or rehabilitation (moderate-quality evidence), traditional acupuncture on a trial basis (very low-quality evidence), and postoperative rehabilitation (supervised program of exercises and/or educational materials encouraging activity) with cognitive-behavioral therapy 12 weeks postsurgery (low-quality evidence). Recommendation 2. In patients LSS causing NC, clinicians and patients may consider a trial of serotonin–norepinephrine reuptake inhibitors or tricyclic antidepressants. (very low-quality evidence). Recommendation 3. For patients LSS causing NC, we recommend against the use of the following pharmacological therapies: nonsteroidal anti-inflammatory drugs, methylcobalamin, calcitonin, paracetamol, opioids, muscle relaxants, pregabalin (consensus-based), gabapentin (very low-quality), and epidural steroidal injections (high-quality evidence).PerspectiveThis guideline, on the basis of a systematic review of the evidence on the nonsurgical management of lumbar spine stenosis, provides recommendations developed by a multidisciplinary expert panel. Safe and effective non-surgical management of lumbar spine stenosis should be on the basis of a plan of care tailored to the individual and the type of treatment involved, and multimodal care is recommended in most situations.     

Treatment of degenerative lumbar spinal stenosis

Spinal stenosis is a narrowing of the vertebral canal that compresses spinal nerves and may cause leg pain and difficulty walking. The symptoms of degenerative lumbar stenosis commonly occur in elderly adults and can be treated conservatively with pain-relieving agents or aggressively with decompressive surgery. Most studies of the effectiveness of treatments are poor in quality; however, there appear to be potential relationships between treatments, patient characteristics, and treatment outcomes. Studies indicate the following: (1) local anesthetic block can reduce symptoms on a short-term basis, while epidural steroids offer no additional benefit; (2) patients with moderate or severe symptoms benefit more from surgery than from conservative therapy; and (3) patients with leg pain and severely restricted walking ability regain mobility after surgery. Definitive evidence-based conclusions about the efficacy of conservative or surgical treatments await the results of well-designed clinical trials.     

脊柱显微内镜在治疗腰椎管狭窄症的临床应用 (附129例报告)

目的 探讨脊柱显微内镜（microendoscopic discectomy，MED）治疗腰椎管狭窄症（1umbar spinalstenosis，LSS）的临床应用价值。方法 应用脊柱显微内镜手术治疗LSS患者129例，其中中央型34例，神经根型35例，侧隐窝型50例，混合型10例。按不同类型分别行椎管减压、神经根管扩大及侧隐窝减压术。结果 术后129例各型腰椎管狭窄症患者，平均随访6．9个月。按NAKAI分级，优：87例，良：38例，可：4例，优良率96．9％。中央椎管型、侧隐窝型、神经根型椎管狭窄3者疗效差异无显著性。3者与混合型椎管狭窄疗效有统计学差异。结论 该术式清晰地显露神经根受压情况，从减压的范围、对脊柱的稳定性及临床疗效上看都是可行的，但对混合型椎管狭窄患者的选择上要慎重。     

The effects of lumbo-pelvic postural taping on gait parameters in patients with lumbar spinal stenosis

BackgroundAltered gait patterns with lumbar-flexed posture threaten the quality of life in patients with lumbar spinal stenosis; however, few studies have developed management strategies to improve gait patterns and lumbo-pelvic posture. The present study investigated the effects of lumbo-pelvic postural taping on pelvic tilt, spatiotemporal gait parameters, and pain during walking in patients with lumbar spinal stenosis.MethodsThe pelvic tilt and gait parameters were assessed in 20 patients with lumbar spinal stenosis before sustained walking using a palpation meter and GAITRite system, respectively. Next, the participants were asked to walk on the ground for 20 min or until they complained of symptoms of neurogenic claudication. Pelvic tilt and gait parameters were measured immediately after the manifestation of neurogenic claudication followed by the application of lumbo-pelvic postural taping. The participants rated the pain intensity using a visual analog scale. Changes in dependent variables among the conditions were analyzed using a one-way repeated-measures analysis of variance.FindingsThe results show a decreased pelvic anterior tilt, walking velocity, and step and stride lengths, as well as an increased base of support and pain after severe symptoms of neurogenic claudication (P < 0.05). However, a greater pelvic anterior tilt, faster walking velocity with a longer step and stride length, and decreased base of support and pain were found after the application of postural taping (P ≤ 0.001).InterpretationThese findings suggest that lumbo-pelvic postural taping can provide beneficial management for improving gait patterns and lumbo-pelvic posture in patients with lumbar spinal stenosis.     

Spinal canal size and clinical symptoms among persons diagnosed with lumbar spinal stenosis

OBJECTIVE: Clinical symptoms associated with lumbar spinal stenosis (LSS) are believed to be due to neurogenic claudication caused by narrowing of the central and lateral spinal canals. However, there is a paucity of published data on these relationships. The purpose of the present study was to examine the relationship between clinical symptoms associated with LSS and osseous anterior-posterior (AP) spinal canal diameter as measured on axial magnetic resonance imaging. DESIGN: Cross-sectional study conducted at a University Spine Program. Fifty persons with a clinical diagnosis of LSS were administered measures of clinical pain and perceived function. Walking distance in the laboratory and community was also assessed. Participants also underwent magnetic resonance imaging of the spine. RESULTS: Using recommended upper limits from the literature, patients with smaller canals reported greater perceived disability, but no other group differences emerged. In the entire sample, AP spinal canal diameter was not significantly associated with any of the clinical symptom measures examined. Body mass index was found to be significantly related to walking distance, but not perceived function or pain. CONCLUSIONS: AP spinal canal diameter is not predictive of clinical symptoms associated with LSS. The findings also suggest that body mass may play a significant role in functional limitations observed in this population.     

Effects of flexion-distraction manipulation therapy on pain and disability in patients with lumbar spinal stenosis

[Purpose] This study examined the effects of flexion-distraction manipulation therapy on pain and disability in patients with lumbar spinal stenosis. [Subjects] Thirty patients with lumbar spinal stenosis were divided into two groups: a conservative treatment group (n=15) and a flexion-distraction manipulation group (n=15). [Methods] The conservative treatment group received conservative physical therapy, and the flexion-distraction group received both conservative physical therapy and flexion-distraction manipulation therapy. Both groups received treatment 3 times a week for 6 weeks. The Visual Analog Scale was used to measure pain intensity, and the Oswestry Disability Index was used to evaluate the level of disability caused by the pain. [Results] The Visual Analog Scale scores for pain were significantly decreased in both groups. In the between-group comparison, the decrease in pain was more significant in the flexion-distraction group. According to the Oswestry Disability Index, the level of disability was significantly decreased in both groups, but the decrease was more significant in the flexion-distraction group. [Conclusion] Flexion-distraction manipulation appears to be an effective intervention for pain and disability among patients with lumbar spinal stenosis.Key words: Spinal stenosis, Flexion-distraction manipulation, Disability     

Manual therapy for lumbar spinal stenosis: a comprehensive physical therapy approach

A physical therapy approach to lumbar spinal stenosis involves techniques directed at opening up the neurovascular spaces in the lumbar spine to reduce the stenosis. This entails manual therapy techniques for improving intervertebral motion, regaining neural mobility, and restoring muscle function, followed by an active exercise program that often involves flexion exercises. Techniques for unloading the spine and patient education are included in this physical therapy approach. A successful functional outcome requires a comprehensive and individualized approach to the patient with spinal stenosis.     

Functional and Patient‐Reported Outcomes in Symptomatic Lumbar Spinal Stenosis Following Percutaneous Decompression

Background: Neurogenic claudication due to symptomatic lumbar spinal stenosis (LSS) is a painful condition causing significant functional disability. While the cause of LSS is multifactorial, thickened ligamentum flavum (LF) accounts for up to 85% of spinal canal narrowing. mild percutaneous lumbar decompression allows debulking of the hypertrophic LF while avoiding the morbidities frequently associated with more invasive surgical procedures. Methods: In this prospective case series study, consecutive LSS patients presenting with neurogenic claudication were treated with percutaneous lumbar decompression. Efficacy was evaluated using the Pain Disability Index (PDI) and Roland‐Morris Disability Questionnaire. Pre‐ and postprocedure Standing Time, Walking Distance, and Visual Analog Score (VAS) were also monitored. Significant device‐ or procedure‐related adverse events were reported. Results: The mild procedure was successfully performed on forty patients. At twelve months, both PDI and Roland‐Morris showed significant improvement of 22.6 points (ANOVA, P < 0.0001) and 7.7 points (ANOVA, P < 0.0001), respectively. Walking Distance, Standing Time, and VAS improvements were also statistically significant, increasing from 246 to 3,956 feet (ANOVA, P < 0.0001), 8 to 56 minutes (ANOVA, P < 0.0001), and 7.1 to 3.6 points (ANOVA, P < 0.0001), respectively. Tukey HSD test found improvement in all 5‐outcome measures to be significant from baseline at each follow‐up interval. No significant device‐ or procedure‐related adverse events were reported. Conclusion: This study demonstrated significant functional improvement as well as decreased disability secondary to neurogenic claudication after mild procedure. Safety, cost‐effectiveness, and quality‐of‐life outcomes are best compared with comprehensive medical management in a randomized controlled fashion and, where ethical, to open lumbar decompression surgery.     

The 2‐Year Cost‐Effectiveness of 3 options to Treat Lumbar Spinal Stenosis Patients

Lumbar spinal stenosis (LSS) may result from degenerative changes of the spine, which lead to neural ischemia, neurogenic claudication, and a significant decrease in quality of life. Treatments for LSS range from conservative management including epidural steroid injections (ESI) to laminectomy surgery. Treatments vary greatly in cost and success. ESI is the least costly treatment may be successful for early stages of LSS but often must be repeated frequently. Laminectomy surgery is more costly and has higher complication rates. Minimally invasive lumbar decompression (mild^®) is an alternative. Using a decision‐analytic model from the Medicare perspective, a cost‐effectiveness analysis was performed comparing mild^® to ESI or laminectomy surgery. The analysis population included patients with LSS who have moderate to severe symptoms and have failed conservative therapy. Costs included initial procedure, complications, and repeat/revision or alternate procedure after failure. Effects measured as change in quality‐adjusted life years (QALY) from preprocedure to 2 years postprocedure. Incremental cost‐effectiveness ratios were determined, and sensitivity analysis conducted. The mild^® strategy appears to be the most cost‐effective ($43,760/QALY), with ESI the next best alternative at an additional $37,758/QALY. Laminectomy surgery was the least cost‐effective ($125,985/QALY).     

Assessment of trunk function in single and multi-level spinal stenosis: a prospective clinical trial

OBJECTIVE: To clarify the biomechanical indicators of single- and multi-level stenosis and to determine the biomechanical outcome of selective conservative decompression. DESIGN: This study is a prospective clinical trial examining trunk function in spinal stenosis patients operated using a conservative procedure in an orthopaedic clinic. BACKGROUND: Although several clinical studies have examined the instability and motion characteristics of operated lumbar spinal canal stenosis, few if any studies have prospectively examined the biomechanical outcome of lumbar spinal canal stenosis surgery. METHODS: Comprehensive pre- and post-operative trunk dynamometer strength and motion analysis tests were performed on 36 patients operated for lumbar canal stenosis. Surgical treatment efficacy was evaluated within a three variable crossed factorial design considering stenosis classification, number of operative levels, and changes in several trunk biomechanical outcomes from pre- to post-operative assessment. Patients were evaluated after a minimum one-year follow-up. RESULTS: Pre-operatively there were no differential effects associated with stenosis classification or number of operated levels. There was a significant post-operative increase in isometric trunk extension torque and flexion-extension power and a return to a more normal trunk extension-flexion torque ratio. Patients with mixed, single level stenosis demonstrated greater trunk extension power both pre- and post-operatively compared to other patients. CONCLUSIONS: Conservative surgical treatment of lumbar spinal stenosis produced a marked improvement in the functional mechanical status of the low back. RELEVANCE: This study assists clinicians and researchers to understand trunk function following conservative surgical treatment of lumbar spinal stenosis.     

A Double‐blind,Randomized, Prospective Study of Epidural Steroid Injection vs. The mild® Procedure in Patients with Symptomatic Lumbar Spinal Stenosis

Background: Epidural steroid injections (ESIs) are commonly used to treat low back pain, including symptomatic lumbar spinal stenosis (LSS). Reports on LSS treatment with ESIs have not differentiated between neurogenic claudication, which is believed to result from nerve root compression, and lumbar radicular pain, thought to be caused by inflammation. While there is overlap between these groups, the clinical relevance of ESI treatment cannot be generalized between these 2 distinct diseases with completely different pathophysiological causes. Methods: This was a double‐blind, randomized, prospective study of ESI vs. the mild procedure in patients with symptomatic LSS, conducted at a single pain management center. Patient reported outcome measures included Visual Analog Scale, Oswestry Disability Index, and Zurich Claudication Questionnaire (ZCQ) patient satisfaction. Results: Thirty‐eight patients were randomized into 2 treatment groups, 21 in mild and 17 in ESI. At 6‐ and 12‐week follow‐up, patients treated with mild reported significantly greater pain decrease over time (P < 0.0001), and significantly greater functional mobility improvement over time (P < 0.0018) than ESI patients. At week 6, mild ZCQ patient satisfaction score of 2.2 indicated a higher level of satisfaction than for ESI with a score of 2.8. In addition, 12‐week ZCQ satisfaction score was 1.8, demonstrating sustained near‐term satisfaction in the mild group. No major mild or ESI device or procedure‐related complications were reported. Conclusions: This study demonstrated that in LSS patients suffering with neurogenic claudication, mild provides statistically significantly better pain reduction and improved functional mobility vs. treatment with ESI.     

126例腰椎管狭窄症开放手术前后诊断分析

目的:结合现行腰椎管狭窄症诊断标准,进一步探讨腰椎管狭窄的病理原因,为临床对该疾病治疗手段的选择提供参考依据.方法:对126例临床诊断为腰椎管狭窄症(LSS)并行手术治疗的病例进行术中测量,根据术前影像与术中所见情况比较分析,甄别实际腰椎管狭窄程度、神经卡压状态及与腰椎间盘突出的关系.结果:所有患者伴有一侧或双侧腰腿痛症状,影像学表现中央型狭窄16例次,腰椎管正中矢状径<10mm;侧隐窝狭窄110例次,侧隐窝高度<3mm.手术中观察发现,实际情况与术前影像相符的病例仅为36例次,部分相符相对狭窄病例共72例,有18例患者术中所见无明显狭窄情况,致病原因由椎间盘突出所致,与术前椎体CT和MRI结果相左.结论:临床LSS诊断仍有局限与不足,术前诊断与术中诊断有较大偏差.对以椎间盘突出为主要因素LSS患者,保守或微创治疗仍然是值得选择的治疗方法.