- Clinical science
Spinal stenosis is characterized by the narrowing of the central spinal canal, intervertebral foramen, and/or lateral recess causing progressive nerve root compression in the cervical, thoracic, or lumbar spine. It is commonly caused by degenerative joint disease in middle-aged or elderly individuals. The main symptoms are neck pain or load-dependent lower back pain with radiation to the buttocks and legs. Spinal extension (standing or walking downhill) exacerbates pseudo- or neurogenic claudication, while back flexion (sitting or walking uphill) improves symptoms. An MRI provides the diagnosis. Treatment involves conservative therapy (analgesia, physiotherapy), while refractory cases require surgical decompression of the spinal cord (laminectomy).
- Prevalence: 5:1000 in persons > 50 years of age
- Age range: middle-aged and elderly population
- Sex: ♀ > ♂ when associated with degenerative disease
Epidemiological data refers to the US, unless otherwise specified.
- Degenerative joint disease (most common)
- Iatrogenic: following spinal surgery such as laminectomy
- Systemic disease: Paget's disease, ankylosing spondylitis, tumors
- Congenital malformations: spinal dysraphism (uncommon)
- Lumbar stenosis
- Cervical or thoracic (rare) stenosis
|Differential diagnosis of neuropathic and vascular claudification|
|Neuropathic claudication||Vascular claudication|
|Clinical features|| |
|Exacerbating factors|| || |
|Relieving factors|| || |
|Ankle-brachial index|| || |
The differential diagnoses listed here are not exhaustive.
- Physiotherapy, which focuses on exercises that promote stability and abdominal muscle strengthening
- Epidural steroid injections if symptoms persist despite above treatment (may improve ∼ 50% of cases)
- Surgery: if conservative therapy fails