Spinal stenosis

Question 1

Types of spinal stenosis

Answer 1

Central stenosis – narrowing of the central spinal canal

Lateral stenosis – narrowing of the nerve root canals

Foramina stenosis – narrowing of the intervertebral foramina

Question 2

Causes of spinal stenosis

Answer 2

Congenital spinal stenosis

Degenerative changes

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

Question 3

Presentation of spinal stenosis

Answer 3

Gradual onset of symptoms

Intermittent neurogenic claudication is a key feature

• Lower back pain
• Buttock and leg pain
• Leg weakness

Symptoms absent at rest and worse on 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

Sciatica in Lateral stenosis and foramina stenosis

Question 4

What does radiculopathy mean?

Answer 4

Compression of the nerve roots as they exit the spinal cord and spinal column, leading to motor and sensory symptoms.

Question 5

What investigations to do in suspected spinal stenosis?

Answer 5

MRI - to diagnose spinal stenosis

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

Question 6

Management of spinal stenosis?

Answer 6

Conservative:

• Exercise and weight loss
• Analgesia
• Physiotherapy

Decompressive surgery where conservative treatment fails - Refer to orthopaedics
- E.g. laminectomy