From the Guidelines
The L2-3 disc bulge with posterior element thickening and facet arthropathy causing moderate central stenosis would typically create neurogenic claudication symptoms, including pain, numbness, tingling, and weakness in the lower back, buttocks, and legs. These symptoms occur because the narrowed spinal canal compresses the cauda equina nerve roots, particularly when the spine is extended during standing or walking 1. Patients may report limited walking distance before needing to rest, and some describe a heavy or tired feeling in their legs. Unlike vascular claudication, these symptoms don't quickly resolve with simply stopping activity but require positional changes like sitting or bending forward to relieve pressure on the nerve roots. Some patients may also experience balance problems or, in severe cases, bowel and bladder dysfunction. The symptoms typically develop gradually as the stenosis progresses, with the body's inflammatory response to nerve compression contributing to symptom severity. Key characteristics of neurogenic claudication include:
- Pain, numbness, tingling, and weakness in the lower back, buttocks, and legs
- Symptoms worsen with standing or walking and improve with sitting or leaning forward
- Limited walking distance before needing to rest
- Heavy or tired feeling in the legs
- Balance problems or bowel and bladder dysfunction in severe cases Initial treatment often includes physical therapy, NSAIDs, and activity modification, with surgical decompression considered if conservative measures fail 1.
From the Research
Symptoms of Lumbar Spinal Stenosis
The patient's condition, L2-3 demonstrates broad-based central disc bulge which in conjunction with posterior element thickening and facet arthropathy creates moderate central stenosis, is likely to cause the following symptoms:
- Low back pain
- Leg pain
- Neurologic intermittent claudication (NIC)
- Radiating pain
- Sensory deficit
Effect of Lumbar Spinal Stenosis on Daily Activities
According to the studies 2, 3, lumbar spinal stenosis can affect a patient's daily activities, such as:
- Walking distance: Patients with lumbar spinal stenosis may experience a decrease in walking distance due to pain and discomfort 3
- Standing or walking: Patients may need to reduce periods of standing or walking to alleviate pain 2
Treatment Options
Treatment options for lumbar spinal stenosis include:
- Nonoperative treatment: Activity modification, oral medications, and physical therapy 2
- Decompressive surgery: May be effective in carefully selected patients with back, buttock, and lower extremity pain who do not improve with conservative management 2
- Gabapentinoids: Pregabalin and gabapentin may be used to relieve pain in lumbar radiculopathy patients who underwent transforaminal epidural steroid injection 4, 5, 3, 6