No drugs, more sex? And Rock’n Roll: effective non-operative treatments and practical management strategies for older adults with lumbar spinal stenosis

Abstract Lumbar spinal stenosis is a growing problem among older adults, associated with significant disability and socio-economic burden. Neurogenic claudication is the most common clinical syndrome caused by LSS with pain being the predominant symptom and limited walking the main impairment. Lumbar spinal stenosis can also impact sexual function in older adults, necessitating greater awareness of this association. Pain and impaired function can lead to psychosocial distress, including hopelessness, anxiety, and isolation, further compounding disability. Recent clinical practice guidelines recommend non-operative treatment as the first-line approach, including manual therapy, exercise, and education. However, these guidelines lack details on the practical application of these interventions in clinical practice. This narrative review explores the epidemiology of lumbar spinal stenosis, the evidence supporting non-operative care, and practical management strategies. It also highlights the relationship between sexual dysfunction and lumbar spinal stenosis.