Spinal stenosis

Clinical Features

• Low back pain that gets progressively worse over time
• Pain relieved with forward flexion (walking uphill)
• Pain worse with extension (walking downhill)

Differential Diagnosis

Differential diagnosis of back pain

Lower Back Pain

• Spine related
  • Acute ligamentous injury
  • Acute muscle strain
  • Disk herniation (Sciatica)
  • Degenerative joint disease
  • Spondylolithesis
  • Epidural compression syndromes
    • Spinal cord compression (non-traumatic)
    • Cauda equina syndrome
    • Conus medullaris syndrome
    • Epidural abscess (spinal)
    • Epidural hematoma (spinal)
  • Thoracic and lumbar fractures and dislocations
  • Cancer metastasis
  • Spinal stenosis
  • Transverse myelitis
  • Vertebral osteomyelitis
  • Ankylosing spondylitis
  • Spondylolisthesis
  • Discitis
  • Spinal Infarct
• Renal disease
  • Kidney stone
  • Pyelonephritis
  • Nephrolithiasis
• Intra-abdominal
  • Abdominal aortic aneurysm
  • Ulcer perforation
  • Retrocecal appendicitis
  • Large bowel obstruction
  • Pancreatitis
• Pelvic disease
  • PID
• Other
  • Retroperitoneal hemorrhage/mass
  • Meningitis

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

See Also

• Lower back pain