Spinal stenosis
Clinical Features
- Lower back pain that gets progressively worse over time
- Pain relieved with forward flexion (walking uphill)
- Pain worse with extension (walking downhill)
- Also known as "neurogenic claudication" as pain can radiate down the leg and is worse with exertion (although not true claudication)
Differential Diagnosis
Differential diagnosis of back pain
Lower Back Pain
- Spine related
- Acute ligamentous injury
- Acute muscle strain
- Disk herniation (Sciatica)
- Degenerative joint disease
- Spondylolithesis
- Epidural compression syndromes
- Thoracic and lumbar fractures and dislocations
- Cancer metastasis
- Spinal stenosis
- Transverse myelitis
- Vertebral osteomyelitis
- Ankylosing spondylitis
- Spondylolisthesis
- Discitis
- Renal disease
- Intra-abdominal
- Abdominal aortic aneurysm
- Ulcer perforation
- Retrocecal appendicitis
- Large bowel obstruction
- Pancreatitis
- Pelvic disease
- PID
- Other
Evaluation
- Check ankle-brachial index (ABI) to rule out vascular claudication
Management
- Avoid alcohol and strengthen legs to prevent falls
- Exercise bike or walking recommended with rest when pain comes
- Pain control
Disposition
- If no cauda equina and pain controlled → outpatient
- As outpatient, can consider referral for decompressive laminectomy for severe persistent pain
See Also
External Links
References
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