Lumbar spine stenosis

Question 1

What are the common pathologies of the lumbar spine?

Answer 1

• stenosis
• herniated disc
• facet joint dysfunction
• instability
• SIJ dysfunction

Question 2

What is the most common form of lumbar spinal stenosis?

Answer 2

intervertebral foraminal stenosis

Question 3

definition: spinal nerve root compression in the intervertebral foramen

Answer 3

intervertebral spinal stenosis

Question 4

definition: potential spinal cord compression (significant central disc herniation)

Answer 4

central canal stenosis

Question 5

What type of lumbar spinal stenosis can cause cauda equina syndrome?

Answer 5

central canal stenosis

Question 6

What is the cause of lumbar spinal stenosis?

Answer 6

degenerative aging process involving:
- disc degeneration
- hypertrophy of facet joints
- osteophytes and bulging discs

Question 7

What are common elements of a lumbar stenosis patient history?

Answer 7

• male, age > 50 y/o
• LBP and/or LE symptoms with standing
• Relief with sitting
• improved walking tolerance with FLX
• pain is worse in the morning

Question 8

Those with lumbar stenosis will have peripheralization with ___ and centralization with ____.

Answer 8

extension, flexion

Question 9

those with lumbar stenosis will have tightness of their ______.

Answer 9

hamstrings, hip flexors

Question 10

Those with lumbar stenosis have weak ___.

Answer 10

hip ext and abd

Question 11

Most patients with lumbar stenosis have pain when lying (prone/supine).

Answer 11

prone

Question 12

When determining neurogenic vs. avascular lumbar stenosis symptoms with a bicycle test, if a patient gets LE symptoms in BOTH positions (flexed and upright) around the same time period or distance ridden, which one is indicated?

Answer 12

vascular

Question 13

When determining neurogenic vs. avascular lumbar stenosis symptoms with a bicycle test, if the patient gets symptoms in the EXT position and does NOT get symptoms in a flexed position or they ride an increased amount of distance before onset, which one is indicated?

Answer 13

neurogenic

Question 14

What are the red flags for lumbar stenosis?

Answer 14

(+) UMN signs
Cancer cluster
cauda equina symptoms

Question 15

What is the cancer cluster?

Answer 15

Age > 50
previous history of cancer
unexplained weight loss
failure to respond to conservative treatment

Question 16

What categorizations of the treatment-based classification system does lumbar spinal stenosis often fit well into?

Answer 16

specific exercise (FLX) and mobilization

Question 17

According to the TBC system, if symptoms of lumbar spinal stenosis are distal to the knee and there is a (+) sign of nerve root compression… _____ can also be warranted.

Answer 17

traction