spinal stenosis

Question 1

what is spinal stenosis?

Answer 1

narrowing of the spinal canal- which compresses the nerve roots

usually occurs in patients over 60 due to degenerative changes

Question 2

which areas are most likely to be affected?

Answer 2

lumbar and cervical

Question 3

what are the 3 types of spinal stenosis?

Answer 3

Central stenosis – narrowing of the central spinal canal
Lateral stenosis – narrowing of the nerve root canals
Foramina stenosis – narrowing of the intervertebral foramina

Question 4

how does spinal stenosis present?

Answer 4

gradual onset

Lower back pain
Buttock and leg pain
Leg weakness

The symptoms are absent at rest and when seated but occur with standing and walking. Bending forward (flexing the spine) expands the spinal canal and improves symptoms. Standing straight (extending the spine) narrows the canal and worsens the symptoms.

Question 5

what is a similar presentation to spinal stenosis?

Answer 5

typical symptoms of intermittent neurogenic claudication. At first glance, they are similar to peripheral arterial disease.

The exam question might specify that the peripheral pulses or the ankle-brachial pressure index (ABPI) are normal, in which case the diagnosis is more likely to be spinal stenosis.

Additionally, patients with spinal stenosis are more likely to struggle with back pain, whereas back pain is not a feature of peripheral arterial disease.

Question 6

which investigations would you do for spinal stenosis?

Answer 6

MRI is the primary imaging investigation for diagnosing spinal stenosis.

Investigations to exclude peripheral arterial disease (e.g., ankle-brachial pressure index and CT angiogram) may be appropriate where symptoms of intermittent claudication are present.

Question 7

what are the management options for spinal stenosis?

Answer 7

Exercise and weight loss (if appropriate)
Analgesia
Physiotherapy
Decompression surgery where conservative treatment fails (with variable results)

Question 8

which conditions can cause spinal stenosis?

Answer 8

Congenital spinal stenosis
Degenerative changes, including facet joint changes, disc disease and bone spurs
Herniated discs
Thickening of the ligamenta flava or posterior longitudinal ligament
Spinal fractures
Spondylolisthesis (anterior displacement of a vertebra out of line with the one below)
Tumours