Spinal Stenosis

If vascular claudication is ruled out, pain in the lower back and lower extremities exacerbated by walking may be diagnosed as neurogenic claudication. This is caused by lumbar spinal stenosis, which results in a narrowing of the central spinal canal and/or the neural foramina (Fig. 26.2) (Deyo and Weinstein 2001). Spinal stenosis is commonly seen in elderly patients in whom degenerative changes in the disks, facet joints as well as including osteophyte formation and thickening of the ligamentum flavum contribute to the narrowing. Spondylolisthesis also can cause these symptoms. Classically, the patient's symptoms are relieved by forward flexion (such as leaning on the grocery cart) and rest. Symptoms may occur in younger patients from congenital stenosis, although this is less common.

Herniated disk

Spinal stenosis

Anulus fibrosus

Herniated nucleus pulposus

Herniated disk

Spinal stenosis

Anulus fibrosus

Herniated nucleus pulposus

Figure 26.2 Herniated disk and spinal stenosis. Modified from Deyo 2001 with permission.

Patients with spinal stenosis may or may not demonstrate neurological changes on physical examination. Diagnosis is confirmed with MRI. Patients may be managed with analgesics and physical therapy. Epidural steroid injections may help. The disease can be progressive and surgery may be considered if pain is severe and disabling.

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