724.02 Spinal stenosis, lumbar region, without neurogenic claudication
724.03 Spinal stenosis, lumbar region, with neurogenic claudication
M48.06 Spinal stenosis, lumbar region
M48.08 Spinal stenosis, sacral and sacrococcygeal region
PREFERRED PRACTICE PATTERN
4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated with Spinal Disorders1
A 64-year-old retired elementary school teacher presents with complaints of intermittent low back pain. She works with the elementary school-aged children, and she would often find herself in a posture of leaning forward to help the students with their work. She spends most of her day in a standing position.
Her pain is in the low back and buttock region and occurs primarily in the standing position. She has noticed that the pain occurs quicker now, and she is not able to stand as long as you used to. If she leans forward over a chair or a shopping cart, the pain is often relieved, but resumes after resuming normal work activities. She used to walk daily with her spouse; however, approximately 10 months ago she started experiencing buttock and calf pain bilaterally during prolonged walking. She is disappointed that she cannot exercise. When walking initially there is no pain, but after about 10 blocks she has low back pain, which gradually intensifies and migrates into both buttocks and thigh, but does not usually radiate into the foot. The pain forces her to sit down at any seat that is available, and she has avoided long shopping trips. Sometimes elevating one leg on a curb can help alleviate the symptoms enough to get back home; however, the pain cycle repeats. There is a flattened lumbar spine and is postured in –5° of hip extension. There is no region of point tenderness over the lumbar spine; there is no palpable gap over the spinous processes. Both feet feel warm. She is able to bend over and reach approximately 62 from the floor. Lateral flexion is 20° in each direction. Maintaining lumbar extension for more than 25 seconds replicates her lower extremity symptoms. ROM of the hip joints are WNL and painless. Generalized hypomobility of all lumbar segments in all directions of movement. Significant loss of movement at L5–S1 and L4–L5. Relative normal strength for age with decreased hamstring and gastroc/soleus flexibility bilaterally.
Axial T2-weighted images of the lumbar spine. (A) A normal thecal sac within the lumbar spinal canal. The thecal sac is bright. The lumbar roots are dark punctuate dots in the posterior thecal sac with the patient supine. (B) The thecal sac is not well visualized due to severe lumbar spinal canal stenosis, partially the result of hypertrophic facet joints. (From Longo ...