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ICD-9-CM Codes

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  • 723.0 Spinal stenosis in cervical region

  • 724.0 Spinal stenosis other than cervical

  • 724.00 Spinal stenosis of unspecified region

  • 724.01 Spinal stenosis–thoracic

  • 724.02 Spinal stenosis, lumbar region, without neurogenic claudication

  • 724.03 Spinal stenosis, lumbar region, with neurogenic claudication

  • 724.09 Spinal stenosis of other region

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ICD-10 Codes

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  • M48.00 Spinal stenosis, site unspecified

  • M48.02 Spinal Stenosis, cervical region

  • M48.04 Spinal stenosis, thoracic region

  • 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 in 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, and paresthesias in the limbs aggravated by walking and relieved by sitting/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 over 65 years of age

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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

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

  • Pain worse with walking, relieved by sitting

  • Can be with or without low back pain (LBP) or neck pain

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

  • Increased symptoms with extension

  • Relief with sitting (lumbar flexion) with lumbar stenosis

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Functional Implications

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  • Difficulty with walking longer distances

  • Difficulty with standing activities

  • Possible bowel/bladder dysfunction with cervical stenosis

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Possible Contributing Causes

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  • Postural changes

  • Weakness of core musculature

  • Tightness of hip flexors, external rotators, and 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 foramen

  • 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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