PubMed1989
In the geriatric patient differential diagnosis of low back pain with sciatica includes degenerative lumbar spinal stenosis, affecting the central canal, the lateral recesses or both. Symptoms usually begin in the sixth decade, but may occur earlier if spinal degeneration is superimposed on congenital stenosis. In the elderly early diagnosis is more difficult to establish, because of the bewildering medical problems and the multiple symptoms rooted in the polypathy and polymorbidity of old age. Typical symptoms include low back pain, claudicatory pains, and paraesthesias of the legs, typically aggravated by standing and relieved by rest. In our series they were present in 100%, 94% and 56% respectively. In our series, the most important clinical investigations confirming diagnosis were pain provocation by reclining and pain relief by inclination (present in 69% of patients) and combined radiographic examination including plain films, computed tomography and myelography. In our experience myelography proved the best single method for early diagnosis. In our elderly patients lateral stenosis was predominant, and therefore lateral decompression by foraminotomy, generally combined with flavectomy, was the most important surgical procedure. In cases with combined lateral and central stenosis, hemilaminectomy or facetectomy was also performed. In follow-up 1 to 5 years after the operation the success rate, determined by very restrictive criteria, was 87%. Therefore, and because failure to establish early diagnosis potentially leads to definitive invalidity, degenerative lumbar spinal stenosis should be considered more frequently in the differential diagnosis of low back pain of the elderly.(ABSTRACT TRUNCATED AT 250 WORDS)