Spinal stenosis

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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

Differential diagnosis of back pain

Lower Back Pain

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

External Links

References