Spinal Stenosis: Symptoms
The most common symptom associated with lumbar spinal stenosis is neurogenic claudication — discomfort that radiates beyond the spinal area into the buttocks and frequently into the thigh and lower leg; it is exacerbated by lumbar extension and improves with lumbar flexion. Patients with symptomatic stenosis are generally comfortable when sitting and have worsening pain with prolonged walking.
Best Radiographic Tests for Spinal Stenosis
Either magnetic resonance imaging (MRI) or computed tomography (CT) may confirm the presence of spinal stenosis, since both modalities can detect the cardinal features of stenosis — reductions in the cross-sectional area of the central canal and neural foramina due to a combination of disk protrusion, redundancy and hypertrophy of facet joints, with accompanying osteophytes. Bony findings such as facet arthropathy can be seen more clearly with CT scans, whereas soft-tissue lesions involving ligaments and disks are better detected with MRI scans. Because CT myelography is invasive and requires intrathecal contrast material, MRI is generally preferred. CT myelography can be used for patients who are not candidates for MRI (e.g., because of clostrophobia or metallic implants) and in rare, specific clinical situations.
Morning Report Questions
Q: What is the Romberg maneuver and what might a positive test indicate?
A: The Romberg maneuver, in which the patient, with eyes closed, stands and is observed for imbalance, may reveal a wide-based gait and unsteadiness. These findings reflect involvement of proprioceptive fibers in the posterior columns. The finding of a wide-based gait among patients with back pain has greater than 90% specificity for lumbar spinal stenosis.
Teaching topics from the New England Journal of Medicine - Vol. 358, No. 8, February 21, 2008