Lumbar Spinal Stenosis

Page Contents

1 WHAT IS IT?
2 WHAT CAUSES IT?
3 WHY IS IT A PROBLEM?
4 WHAT MAKES US SUSPECT IT?
5 HOW DO WE CONFIRM A DIAGNOSIS?
6 HOW DO WE RULE OTHER DIAGNOSES OUT?
7 HOW DO WE TREAT IT?
8 HOW WELL DO THE PATIENTS DO?
9 WAS THERE A WAY TO PREVENT IT?
10 WHAT ELSE ARE WE WORRIED ABOUT?
11 OTHER HY FACTS?
12 FURTHER READING

WHAT IS IT?

Lumbar spinal stenosis refers to the narrowing of the space in which the spinal cord travels.

Anatomy of pupillary constriction (source)

WHAT CAUSES IT?

Typically this is caused by processes associated by aging such as degenerative joint disease (DJD).

WHY IS IT A PROBLEM?

This process can be painful and can lead to irreversible damage by impinging on nerves within the spinal canal.

WHAT MAKES US SUSPECT IT?

Risk factors

Older age (<60 years)

Initial Presentation:

Common Chief Complaints:

Radiating gluteal or lower back pain/burning/discomfort
Impairment of walking
Sensory loss
Paresthesias
Muscle weakness

History Of Present Illness:

Pain is worsened by:

Standing
Walking downhill

Pain is improved by:

Sitting
Walking uphill (relative to walking downhill)

Physical Exam Findings

Visual inspection: can show atrophy of the lower extremity muscles.

Motor exam: can show lower extremity weakness.

Sensory exam: decreased sensation (in all modalities) can be present in the lower extremities

Reflex exam: decreased/absence Achilles reflex may be observed.

HOW DO WE CONFIRM A DIAGNOSIS?

MRI is the preferred imagining modality for confirming the diagnosis of lumbar stenosis

MRI scan can show spinal stenosis the most clearly (source)

HOW DO WE RULE OTHER DIAGNOSES OUT?

MRI really in most cases will be needed to rule out other pathology that might cause the symptoms of spinal stenosis (such as cauda equina syndrome)

HOW DO WE TREAT IT?

Physical therapy can provide patients with some pain relief (in certain cases)

Surgery is typically needed for patients who are symptomatic.

HOW WELL DO THE PATIENTS DO?

Patient prognosis depends on the severity of the stenosis, and if irreversible damage has been done to nerves.

WAS THERE A WAY TO PREVENT IT?

N/A

WHAT ELSE ARE WE WORRIED ABOUT?

Irreversible nerve damage is a concern in patients who have acutely progressing symptoms.