Spinal Stenosis Flashcards
hx
73 yr old M bricklayer 6 month hx of bilateral buttock and leg pain worse with prolonged standing and relieved by sitting. Relief when shopping, pushing trolley, can exercise comfortably on exercise bike at home. No near symptoms of lower limbs/ saddle anaesthesia/ urinary retention/ faecal incontinence
look
loss of lumbar lordosis
no obvious scoliosis/ spinal scars
sagittal and coronal balance
active movement
possible limited active ROM of lumbar spine
passsive and resisted movements
not expected
special tests
SLR test
Wall test - show loss of lumbar lordosis
other tests
lower limb neuro exam
peripheral vascular exam lower limb
DDx
spinal stenosis/ neurogenic claudication
vascular claudication
spondylolithesis
prolapsed disc
why is spinal stenosis likely?
pain on standing/ walking, relieved by sitting, loss of lumbar lordosis
why is vascular claudication unlikely?
difficult ddx
normal peripheral vascular exam lower limb
why is spondylolithesis unlikely?
much longer pain hx, increase in lumbar lordosis
why is prolapsed disc unlikely?
normal lower limb neuro exam
investigations
xray
MRI
Xray lumbosacral spine standing AP and lateral
maybe clearer with flexion extension views
disk space narrowing osteophyte formation degenerative scoliosis spondylolithesis spondylolysis
MRI
central stenosis
obliteration of theca fat
degenerative changes of facet joints leading to osteophyte formation
ligamentum flavum hypertrophy
CT myelogram if
MRI C/I
See disruption in radio-opaque dye
