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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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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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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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  • To hospital for imaging
  • To physician for surgical consult if myelopathy suspected
  • To physician for imaging and medical consult if disease suspected
  • To physician for If vascular insufficiency suspected

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  • Hypomobile lumbar ...

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