Spinal stenosis: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
* | *[[Lower back pain]] that gets progressively worse over time | ||
*Pain relieved with forward flexion (walking uphill) | *Pain relieved with forward flexion (walking uphill) | ||
*Pain worse with extension (walking downhill) | *Pain worse with extension (walking downhill) | ||
**Also known as "neurogenic claudication" as pain can radiate down the leg and is worse with exertion (although not true [[claudication]]) | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Disposition== | ==Disposition== | ||
*If no [[cauda equina]] and pain controlled | *If no [[cauda equina]] and pain controlled → outpatient | ||
*As outpatient, can consider referral for decompressive laminectomy for severe persistent pain | *As outpatient, can consider referral for decompressive laminectomy for severe persistent pain | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Neurology]] | |||
[[Category:Surgery]] | |||
Latest revision as of 00:32, 6 February 2021
Background
Clinical Features
- Lower back pain that gets progressively worse over time
- Pain relieved with forward flexion (walking uphill)
- Pain worse with extension (walking downhill)
- Also known as "neurogenic claudication" as pain can radiate down the leg and is worse with exertion (although not true claudication)
Differential Diagnosis
Lower Back Pain
- Spine related
- Acute ligamentous injury
- Acute muscle strain
- Disk herniation (Sciatica)
- Degenerative joint disease
- Spondylolithesis
- Epidural compression syndromes
- Thoracic and lumbar fractures and dislocations
- Cancer metastasis
- Spinal stenosis
- Transverse myelitis
- Vertebral osteomyelitis
- Ankylosing spondylitis
- Spondylolisthesis
- Discitis
- Spinal Infarct
- Renal disease
- Intra-abdominal
- Abdominal aortic aneurysm
- Ulcer perforation
- Retrocecal appendicitis
- Large bowel obstruction
- Pancreatitis
- Pelvic disease
- Other
Evaluation
- Check ankle-brachial index (ABI) to rule out vascular claudication
Management
- Avoid alcohol and strengthen legs to prevent falls
- Exercise bike or walking recommended with rest when pain comes
- Pain control
Disposition
- If no cauda equina and pain controlled → outpatient
- As outpatient, can consider referral for decompressive laminectomy for severe persistent pain