Spinal stenosis is a condition typically resulting from degenerative changes in the lumbar spine.
Neurogenic claudication characterized by back and leg pain and lower extremity paresthesia brought on by ambulation and relieved by sitting.
Lumbosacral spine radiographs 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 nonsteroidal anti-inflammatory drugs and physical therapy. 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.
Neurologic 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 disk 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
- onset and duration of symptoms
- back pain
- activity-related back pain
- leg pain when walking
- stooped posture when walking
- leg numbness or paresthesias
- absence of exam findings
Other diagnostic factors
- pain radiating down the leg
- bladder or bowel dysfunction
- muscle weakness or wasting
- age over 40 years
- manual labor
- 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 neurologic deficit
no significant acute neurologic deficit: pain affecting quality of life and/or functional activities
- Peripheral vascular disease
- Lumbosacral intervertebral disk herniation
- Spinal compression fracture
- Natural course and diagnosis of lumbar spinal stenosis: WFNS Spine Committee recommendations
- ISSLS prize winner: consensus on the clinical diagnosis of lumbar spinal stenosis: results of an international delphi study
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