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Lumbar stenosis - Coggle Diagram
Lumbar stenosis
Subjective
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Radiating pain/numbness to buttock, thigh or leg.
Ease: resting, sits down, or bends forward.
Agg: Walking of standing for long periods this is due to narrowing of vertebral canal and foramen in these positions. Also extension or even standing up straight.
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Shopping cart sign, easier up stairs than down.
Pathology
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Can effect the lower spinal canal (central stenosis) or one or more lumbar vertebral foramina (foraminal/lateral stenosis).
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Neurogenic Claudication - Means spinal cord or route becoming entrapped. This is due to due to narrowing of canal or intervertebral foreman.
Stenosis is the name for the actual narrowing of the canal, while myelopathy indicates injury to the spinal cord and its function.
Radicular pain, radiculopathy - compressed or irritated nerve roots resulting in different symptoms.
Differentials
Lumbar radicular syndrome - Often younger, sharp and burning. Mostly unilateral, provocation includes, increasing pressure, coughing, standing walking, sitting. Prefers lying down.
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Research
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No concrete evidence. One weak systematic review stating exercise had similar effect to decompressive laminectomies.
Cochrane review 2016 states: No clear benefits were observed with surgery versus non-surgical treatment. These findings suggest that clinicians should be very careful in informing patients about possible treatment options, especially given that conservative treatment options have resulted in no reported side effects.
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Treatment
Lifestyle advice, losing weight, increase activity as possible.
Conservative, surgery if no improvement.
Patient education, key points: change position frequently, know and respect limits, and to pace daily activities.
Tests
Bike test, no/less pain as lack of extension.
Cluster of Cook et al. 2011 (Sens 96% - 0/5, Spec 98% - 4+/5).
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