Summary
Definition
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
Risk factors
- age over 40 years
- manual labor
- previous back surgery
- family history of back pain
- smoking
- diabetes mellitus
- peripheral vascular occlusive disease
- previous injury
- achondroplasia
- acromegaly
Diagnostic tests
1st tests to order
- plain x-ray
- MRI (T2-weighted)
Tests to consider
- CT myelography
- CT spine
- electromyographic (EMG) walking test
- electromyographic paraspinal mapping
Treatment algorithm
significant acute neurologic deficit
no significant acute neurologic deficit: pain affecting quality of life and/or functional activities
chronic symptoms
Contributors
Authors
Michael David Tseng MD, MD
Clinical Assistant Professor
Department of Orthopaedic Surgery
Stanford University School of Medicine
Stanford
CA
Disclosures
MDT declares that he has no competing interests.
Acknowledgements
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.
Disclosures
WAA and AMP are authors of references cited in this topic. JKH and MC declared that they had no competing interests.
Peer reviewers
John Ratliff, MD, FAANS, FACS
Associate Professor
Department of Neurosurgery
Stanford University
Stanford
CA
Disclosures
JR declares that he has no competing interests.
References
Key articles
Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop Relat Res. 1982 May;(165):110-23. Abstract
Jane JA Sr, Jane JA Jr, Helm GA, et al. Acquired lumbar spinal stenosis. Clin Neurosurg. 1996;43:275-99. Abstract
Garfin SR, Herkowitz HN, Mirkovic S. Nonoperative and operative treatment of lumbar stenosis. In: Rothman R, Simeone F, eds. The spine. 3rd ed. Philadelphia, PA: WB Saunders; 1991:857-75.
Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976). 2010 Jun 15;35(14):1329-38.Full text Abstract
Zdeblick TA. The treatment of degenerative lumbar disorders: a critical review of the literature. Spine (Phila Pa 1976). 1995 Dec 15;20(24 Suppl):126S-37S. Abstract
Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med. 2007 May 31;356(22):2257-70.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Peripheral vascular disease
- Lumbosacral intervertebral disk herniation
- Spinal compression fracture
More DifferentialsGuidelines
- 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
More GuidelinesPatient information
Spinal stenosis
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