Symptoms of spinal claudication can be distinguished from vascular claudication because they are frequently associated with neurological symptoms, are often worse in extension, and pedal pulses are present on clinical examination. Classic symptoms: back, buttock, thigh and calf pain provoked by walking and extended posture and relieved by flexed posture
About
- Spinal stenosis may be defined as any type of narrowing of the spinal canal, nerve root canal or intervertebral foramen.
- The resultant nerve root compression leads to nerve root ischaemia, presenting with back, buttock or leg pain provoked by exercise.
Aetiology
- Spinal stenosis may be congenital, as is the case in achondroplasia
- Acquired degenerative types (commonly presenting between 50 and 70 years of age).
- Narrowing is caused by facet joint hypertrophy, disc bulging and ligamentum flavum thickening.
Associations
- Congenital spinal stenosis, including with achondroplasia and idiopathic forms.
- Degenerative causes of stenosis.
- Spondylolisthesis or spondylolysis-related stenosis.
- Iatrogenic causes, such as post-laminectomy stenosis.
- Post-traumatic and metabolic conditions, such as Paget disease, leading to stenosis.
Clinical Features
- More common in women than men.
- Symptoms include back and buttock pain, leg pain with walking, progressive numbness in the legs, claudication, and falls.
Investigations
- MRI: Non-invasive and effective in assessing lumbar stenosis.
- CT: Useful alternative imaging modality.
- Myelography with CT: Water-soluble myelography followed by CT can also aid in evaluating the extent of stenosis.
Differential Diagnosis
- Vascular claudication.
- Hip joint disorders.
- Peripheral neuropathy.
- Note: Some patients may present with both vascular claudication and spinal stenosis.
The condition may be treated successfully by surgical decompression alone with preservation of the facet joints.
Management
- Non-operative management is often effective but aymptoms progress in up to one-third of untreated patients who may need surgery:
- Bed rest and NSAIDs or paracetamol/acetaminophen for pain management.
- Structured exercise programs for aerobic fitness and symptom relief.
- Epidural steroid injections may be considered for symptom control.
- Surgical decompression may be considered if conservative measures fail.