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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

  • 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


  • 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

Essentials of Diagnosis

  • 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

General Considerations

  • 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


  • Prevalence increases with age
  • Primarily occurs over 65 years of age

Signs and Symptoms

  • 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

Functional Implications

  • Difficulty with walking longer distances
  • Difficulty with standing activities
  • Possible bowel/bladder dysfunction with cervical stenosis

Possible Contributing Causes

  • Postural changes
  • Weakness of core musculature
  • Tightness of hip flexors, external rotators, and hamstrings

Differential Diagnosis

  • Vascular insufficiency
  • Peripheral nerve impairment
  • Hip pathology with radiating pain pattern
  • Osteoarthritis
  • Spinal tumor
  • Peripheral neuropathy
  • Degenerative Disk disease


  • 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

  • Physical Examination
    • Algorithm for examination of the lumbar spine
    • Two-stage treadmill test
    • Ankle-brachial index (ABI) to screen for peripheral arterial disease (PAD)
    • Quadrant test
    • Straight leg raise test
    • Crossed ...

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