Spinal stenosis

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

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