Neurogenic claudication/stenosis

Diagnosis and presentation

Definition

Spinal stenosis describes a narrowing of the spinal canal that gives rise to symptoms of compression of the spinal nerves.

Cause

Degenerative changes in the lower back usually as part of the aging process which causes a partial constriction. The nerves within the spine are compressed by the constriction and their blood supply is temporarily reduced by the compression.

Prevalence

Spinal stenosis is a common problem particularly with older people.
13-14% of patients attending a spinal surgeon in the US have severe bony stenosis requiring surgical decompression (Watters et al, 2008).
Little is known about the natural history and prognosis of stenosis.

Presentation

The symptoms experienced are those of back pain and leg pain.

Numbness or weakness or feelings of unsteadiness in either one or both legs.

Symptoms occur with walking and/or standing.

Symptoms ease with sitting.

Differential Diagnosis

Vascular claudication
Diabetes
Vitamin B12 deficiency

Clinical testing

MRI is the most appropriate, non-invasive test.

Electrodiagnostic studies do not enhance the diagnosis or treatment of lumbar stenosis.

Management

See general conservative treatment advice

Progression and escalation

Progressing as expected (up to 3 Rxs) before discharge or onward referral.

Consider general progression/escalation advice.

60-70% ISQ

15-20% worse

15-20% better

Evidence

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE, Clinical Knowledge Summaries [Homepage of NICE], [Online]. Available: http://cks.nice.org.uk/ [15/2/22].

WATTERS, W.C.,3RD, BAISDEN, J., GILBERT, T.J., KREINER, S., RESNICK, D.K., BONO, C.M., GHISELLI, G., HEGGENESS, M.H., MAZANEC, D.J., O'NEILL, C., REITMAN, C.A., SHAFFER, W.O., SUMMERS, J.T., TOTON, J.F. and NORTH AMERICAN SPINE SOCIETY, 2008. Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. The spine journal : official journal of the North American Spine Society, 8(2), pp. 305-310. Click here for full text (link correct as at 15/2/22)