Spinal stenosis is a condition typically resulting from degenerative changes in the lumbar spine.
Neurogenic claudication characterised by back and leg pain and lower extremity paraesthesia brought on by ambulation and relieved by sitting.
Lumbosacral spine x-rays and computed tomography scans show degenerative changes and possibly spondylolisthesis, but magnetic resonance imaging is the best technique to show neural element compression in the spinal canal and foramina.
Initially treated with non-steroidal anti-inflammatory drugs and physiotherapy. Epidural corticosteroid injections may provide symptomatic relief.
More severe or persistent symptoms that significantly interfere with function are likely to benefit from decompressive spinal surgery, possibly with fusion if there is degenerative spondylolisthesis or degenerative scoliosis.
Neurological deficit including sensory or motor loss occurs in up to 30% of patients, and patients may experience severe morbidity from reduction in the ability to walk.
Lumbar spondylosis refers to degenerative conditions of the lumbar spine that narrow the spinal canal, lateral recesses, and neural foramina. Facet joint and ligamentous hypertrophy, intervertebral disc protrusion, and spondylolisthesis may all contribute to the stenosis, and symptoms result from neural compression of the cauda equina, exiting nerve roots, or both. Patients present with symptoms of neurogenic claudication or radiculopathy.
History and exam
Key diagnostic factors
- presence of risk factors
- onset and duration of symptoms
- back pain
- activity-related back pain
- leg pain when walking
- stooped posture when walking
- leg numbness or paraesthesiae
- absence of examination findings
Other diagnostic factors
- pain radiating down the leg
- bladder or bowel dysfunction
- muscle weakness or wasting
- age >40 years
- manual labour
- previous back surgery
- family history of back pain
- diabetes mellitus
- peripheral vascular occlusive disease
- previous injury
1st investigations to order
- plain x-ray
- MRI (T2-weighted)
Investigations to consider
- CT myelography
- CT spine
- electromyographic (EMG) walking test
- electromyographic paraspinal mapping
significant acute neurological deficit
no significant acute neurological deficit: pain affecting quality of life and/or functional activities
Michael David Tseng MD, MD
Clinical Assistant Professor
Department of Orthopaedic Surgery
Stanford University School of Medicine
MDT declares that he has no competing interests.
Dr Michael David Tseng would like to gratefully acknowledge Dr Adam M. Pearson, Dr William A. Abdu, Dr John K. Houten, and Dr Mark Chwajol, previous contributors to this topic. WAA is an author of a reference cited in this topic. JKH and MC declare that they have no competing interests.
WAA and AMP are authors of references cited in this topic. JKH and MC declared that they had no competing interests.
John Ratliff, MD, FAANS, FACS
Department of Neurosurgery
JR declares that he has no competing interests.
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