stenosis - exam 1

Question 1

what is stenosis?

Answer 1

narrowing around and compression of neurological structures

Question 2

stenosis is the most common diagnosis for spinal surgery in ______

Answer 2

adults > 60 years of age

Question 3

what age group typically gets stenosis?

Answer 3

> 65 years of age
younger due to spondylolisthesis

Question 4

can imaging show canal narrowing in asymptomatic individuals?

Answer 4

yes - 30%

Question 5

What are the 2 causes/pathogenesis of stenosis?

Answer 5

compression from outside in - narrowing of spinal canal (unilateral due to age related disc and joint changes, instability, or enfolding of ligamentum flavum)

compression from inside out
- fibrotic nerves won’t expand due to persistent inflammation
- increased blood supply to nerve w activity causes n. to enlarge (part. walking)
- fibrotic nerve wont expand, compression results from inside out
same result as narrowing but different mechanism

Question 6

what structures are affected by stenosis and what’s happening to cause that?

Answer 6

spinal nerve
radicular arterial supply

ischemic compression and venous congestion

Question 7

if nervous system is involved, drainage takes longer because

Answer 7

no lymphatic vessels in PNS or CNS –> once inflammed, the inflammatory phase is longer

Question 8

what are lateral stenosis symptoms?

Answer 8

unilateral LE > LBP w segmental paresthesias and gripping type P! due to ischemia
decreased LE > LBP - FB/sitting/AM (flexion)
increased LE > LBP - standing/walking (extension)

Question 9

why would symptoms be greater with level walking vs incline walking?

Answer 9

you’re in a slightly flexed position when walking on an incline

Question 10

what would the PT find in a scan with lateral stenosis?

-Observation?
-ROM?
-Neuro (+ or -) for ?
-Stress test?

Answer 10

observation:
slouched (to get out of lordosis)
possible scoliosis (frontal & transverse plane malpositioning –> closes the foramen)

ROM:
Flexion/contralateral SB decreased LE and LBP but may demonstrate limited motion due to not being able to open foramen
extension/ipsilateral SB increased LE and LBP and may demonstrate limited motion due to contact with spinal n.
Rot inconsistently produces symptoms

Neuro:
likely (+) for radiculopathy

stress tests:
possible (+) PA pressure/torsion when sustained (prolonged hold = persistent)

Question 11

what would the PT find in a biomechanical exam with lateral stenosis?

accessory motion?
muscle stabilization?
Special tests?

Answer 11

AM:
hypomobility
– in adjacent joints: lower thoracic & upper lumbar and LE esp hip (not enough hip hyperext.)
– in lumbar flexion and contralateral SB (not opening and sliding superiorly as it should)

impaired local muscle stabilization

special tests:
stability - possible excessive shearing
LE discrepancies
balance deficits w wide based gait
cooks CPR

Question 12

what is Cooks CPR?

Answer 12

bilateral symptoms
LE P! > LBP
standing/walking P!
P! relief w sitting
> 48 years of age

Question 13

what is the ankle brachial index test testing for?

Answer 13

possible peripheral arterial disease

Question 14

what specific test is used to determine if it is stenosis or PAD?

Answer 14

bicycle test
cycle upright (slight ext) then bend to lean on handlebars for 3 minutes each
stenosis –> pain will decrease with bent position
PAD –> pain doesn’t decrease w bent position

Question 15

what are unique central stenosis S&S?

Answer 15

cord or cauda equina syndrome S&S
likely no changes with SB or rot

Question 16

what is PT Rx for stenosis?

Answer 16

pt education of foramen and good prognosis
directional preference into flx
intermittent traction may be helpful w radiculopathy, esp if no centralization
MT:
– JM
– manipulation
neural mobilizations

Question 17

what is the most effective MT for sub group of stenosis w LBP?

Answer 17

manipulation
- lower thoracic
- lumbar manipulation most effective when combined w exercise
- early evidence of support for addition of hip joint manipulation

Question 18

how would you prescribe MET for a patient with stenosis to focus on foraminal opening?

Answer 18

aerobic component
– unweighted walking
– recumbent bike/cycling as effected as unweighted walking (puts in flx position)
– primary influence may be on circulation improvements
balance training only as able to be upright without symptoms
local muscle stabilization
corsets - more foraminal space but don’t put into ext

Question 19

what are indications that surgery may be needed for stenossi?

Answer 19

presence of constant and/or worsening symptoms
failure to obtain relief w 3-6 months of non surgical treatments

Question 20

what would be outcomes of surgery for stenosis?

Answer 20

inconclusive BEST sx w spinal decompression of laminectomy and/or partial discectomy without or with fusion
benefit w P!/disability but walking distance not better
outcome can be like comprehensive PT if just stenosis
stenosis w spondylolythesis - substantially greater pain relief and improvement in function vs PT at 4 years