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Condition/Disorder Synonyms

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  • Cervical spinal stenosis

  • Cervical central stenosis

  • Central stenosis

  • Lateral stenosis

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ICD-9-CM Code

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  • 723.0 Spinal stenosis in cervical region

  • 724.0Spinal stenosis other than cervical

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ICD-10-CM Code

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  • M48.00 Spinal stenosis, site unspecified

  • M48.02 Spinal Stenosis, cervical region

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Preferred Practice Pattern1

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Key Features

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Description

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  • Common, degenerative spinal condition

  • Associated with narrowing of the spinal canal (central stenosis) or foraminal canals (lateral stenosis)

  • Caused by degenerative changes in intervertebral discs and facet joints

  • Can result in spinal cord compression or nerve root compression

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Essentials of Diagnosis

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  • Causes neurogenic claudication, with pain, cramping, and paresthesias in the upper extremity and lower extremity aggravated by cervical extension, relieved by cervical flexion

  • Diagnosis made by clinical examination

  • Differentiation between vascular and neurologic claudication

  • Reproduction of symptoms in specific postures and activities

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General Considerations

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  • Cervical spinal stenosis can result in spinal cord compression and resulting upper motor neuron signs

  • Cervical central stenosis can give both upper and lower extremity symptoms

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Demographics

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  • Prevalence increases with age

  • Primarily occurs after 65 years of age

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Clinical Findings

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Signs and Symptoms

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  • Bilateral leg pain

  • Unilateral or bilateral upper limb pain and myelopathy with cervical stenosis

  • Pain worse with walking, relieved by sitting

  • Can be with or without neck pain

  • Altered sensation, motor control, and reflexes in the distribution of the involved nerve roots

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Functional Implications

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  • Difficulty with walking long distances

  • Difficulty with standing activities

  • Possible bowel or bladder dysfunction with cervical stenosis

  • Difficulty looking up

  • Difficulty reaching overhead, painting overhead

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Possible Contributing Causes

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  • Postural changes

  • Weakness of core musculature

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Differential Diagnosis

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  • Vascular insufficiency

  • Peripheral nerve impairment

  • Thoracic outlet syndrome

  • Osteoarthritis

  • Spinal tumor

  • Peripheral neuropathy

  • Degenerative disk disease

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Means of Confirmation or Diagnosis

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Imaging

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  • MRI helps to visualize compressed or inflamed nerve root in diagnosis

  • X-ray/plain-film radiograph helpful if osteophyte located in intervertebral foramen

  • CT scan to show herniation compressing the spinal canal/nerves

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Diagnostic Procedures

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  • Electrodiagnostic/nerve conduction testing can help determine a specific impaired nerve function

  • Doppler ultrasound to examine vascular function

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Findings and Interpretation

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  • Physical examination

    • Two-stage treadmill test

    • ABI to screen for PAD

    • Quadrant test

    • Slump test

    • Upper limb nerve tension test

    • Deep tendon reflexes

    • Upper motor neuron testing, including tone, pathological reflexes

    • Upper/lower limb sensation testing

    • Passive physiological intervertebral mobility testing ...

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