Stenosis, spinal

• 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

• Pattern 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated With Spinal Disorders

Description

• 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

Demographics

• 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

Imaging

• 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 ...