[1] Decompressive spinal surgery may modestly improve outcomes but carries greater risk than conservative treatment.

[1] Overall, there is limited supporting evidence to determine the most effective surgical or nonsurgical treatment for people with symptomatic LSS.

[6] Pseudoclaudication, now generally referred to as neurogenic claudication, typically worsens with standing or walking, and improves with sitting, and is often related to posture and lumbar extension.

When the discomfort does not occur while seated, the likelihood of lumbar spinal stenosis increases considerably, around 7.4 times.

[8] Spinal stenosis may be congenital (rarely) or acquired (degenerative), overlapping changes normally seen in the aging spine.

The articular facets, also in the posterior portion of the bony spine can become thickened and enlarged, causing stenosis.

[citation needed] Forward displacement of a proximal vertebra in relation to its adjacent vertebra in association with an intact neural arch, and in the presence of degenerative changes, is known as degenerative spondylolisthesis,[9][10] which narrows the spinal canal, and symptoms of spinal stenosis are common.

Frymoyer showed that spondylolisthesis with canal stenosis is more common in diabetic women who have undergone oophorectomy (removal of ovaries).

[citation needed] The normal lumbar central canal has a midsagittal diameter (front to back) greater than 13 mm, with an area of 1.45 cm2.

The definitive diagnosis is established by either computerized tomography or magnetic resonance imaging (MRI) scanning.

Although diagnostic progress has been made with newer technical advances, the bicycle test remains an inexpensive and easy way to distinguish between claudication caused by vascular disease and spinal stenosis.

[18] MRI is the preferred method of diagnosing and evaluating spinal stenosis of all areas of the spine, including cervical, thoracic, and lumbar.

[22][23][24] The detection of spinal stenosis in the cervical, thoracic, or lumbar spine confirms only the anatomic presence of a stenotic condition.

These findings, taken from the history and physical examination of the patient (along with the anatomic demonstration of stenosis with an MRI or CT scan), establish the diagnosis.

[7] Overall scientific evidence is inconclusive on whether conservative approach or a surgical treatment is better for lumbar spinal stenosis.

[7][needs update] Nonsteroidal anti-inflammatory drugs, muscle relaxants, and opioid analgesics are often used to treat low back pain, but evidence of their efficacy is lacking.

[7] Another procedure using an interspinous distraction device known as X-STOP was less effective and more expensive when more than one spinal levels are repaired.

For example, magnetic resonance imaging (MRI) and computed tomography (CT) are the most common ways to diagnosis LSS, but clinically significant definitions of canal, foraminal, or subarticular narrowing do not exist.

[citation needed] In addition to this, the lumbar and cervical types are more common than the rarer thoracic stenosis.

[33] Because of this, there has been a recent increasing trend seen by physicians, of lumbar spinal stenosis being more commonly diagnosed in older patients.

[37] From this population, a large portion of radicular pain stems not from disk pathology, but from lumbar spinal stenosis.

[39] It is estimated that around 200,000 adults are affected by LSS in the United States and that by the year 2025, this number will rise to 64 million elderly.

[41] It went on to state that while the disease is strongly related to aging, men are affected earlier in life than women.

[33] Occupation, race, and smaller canal diameter also do not appear to have a correlation with the development of spinal stenosis.

[45] A normal-sized lumbar canal is rarely encountered in persons with either disc disease or those requiring a laminectomy.

[31] During the 1970s and 1980s, many case reports showed successful surgical treatment rates, but these were based on subjective assessment by surgeons.

[46] The investigators concluded that observation is a reasonable treatment option for lumbar stenosis and that significant neurologic deterioration is rare.

"[7] Under rules promulgated by Titles II and XVI of the United States Social Security Act, spinal stenosis is recognized as a disabling condition under Listing 1.04 C. The listing states: "Lumbar spinal stenosis resulting in neurogenic claudication, established by findings on appropriate medically acceptable imaging, manifested by chronic nonradicular pain and weakness, and resulting in inability to ambulate effectively, as defined in 1.00B2b.