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ICD-9-CM Codes

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  • 724.02 Spinal stenosis, lumbar region, without neurogenic claudication

  • 724.03 Spinal stenosis, lumbar region, with neurogenic claudication

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ICD-10 CM Codes

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  • M48.06 Spinal stenosis, lumbar region

  • M48.08 Spinal stenosis, sacral and sacrococcygeal 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 to intervertebral discs and facet joints

  • Can result in spinal cord compression, cauda equina compression, or nerve root compression

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Essentials of Diagnosis

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  • Can result in neurogenic claudication, with pain, cramping, paresthesias in the lower limbs aggravated by walking and relieved by sitting or 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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  • Lumbar spinal stenosis can result in spinal cord compression, loss of bowel and bladder control

  • Cervical central stenosis can cause bilateral symptoms in lower extremity

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Demographics

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  • Prevalence increases with age

  • Primarily occurs people aged 65 years or older

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Clinical Findings

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Signs and Symptoms

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  • Unilateral or bilateral leg pain with lumbar stenosis

  • Pain worsens with walking, relieved by sitting

  • May be with or without low back pain or neck pain

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

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Functional Implications

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  • Difficulty walking longer distances

  • Difficulty with standing activities

  • Possible bowel or bladder dysfunction

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Possible Contributing Causes

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  • Postural changes

  • Weakness of core musculature

  • Tightness of hip flexors, external rotators, hamstrings

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Differential Diagnosis

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  • Vascular insufficiency

  • Peripheral nerve impairment

  • Hip pathology with radiating pain pattern

  • 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 helpful in diagnosis to visualize compressed or inflamed nerve root

  • X-ray/plain film radiograph helpful if osteophyte located in intervertebral foramen3

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

  • Electrodiagnostic/nerve conduction testing can assist to 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

    • Ankle-brachial pressure index (ABPI) to screen for peripheral artery disease

    • Quadrant test

    • Straight leg raise test

    • Crossed straight leg raise test

    • Slump test

    • Lower limb nerve tension test

    • Deep tendon reflexes

    • Upper motor neuron tests, including tone, pathological reflexes

    • Lower limb sensation testing

    • Passive physiological intervertebral mobility testing (PPIVM)

    • Postural examination

    • Muscle length tests, including ...

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