Spinal stenosis

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Spinal stenosis is "narrowing of the spinal canal."[1][2] Spinal stenosis is a cause of low back pain.


Cause/etiology

One cause is spondylolisthesis.

Diagnosis

A clinical prediction rule exists to help diagnose spinal stenosis based on the history and physical.[3]

According to a systematic review by the Rational Clinical Examination: [4] The most useful symptoms for increasing the likelihood of spinal stenosis are:

  • Having no pain when seated (LR, 7.4; 95% CI, 1.9-30)
  • Improvement of symptoms when bending forward (LR, 6.4; 95% CI, 4.1-9.9)
  • Bilateral buttock or leg pain (LR, 6.3; 95% CI, 3.1-13)
  • Neurogenic claudication (LR, 3.7; 95% CI, 2.9-4.8)

The most useful symptoms for decreasing the likelihood of spinal stenosis are:

  • Absence of neurogenic claudication (LR, 0.23; 95% CI, 0.17-0.31)

Treatment

Steroid injections

According to a randomized controlled trial, steroid injections do not provide meaningful benefit.[5]

Surgery

Surgery may improve outcome at two years in patients with spinal stenosis not from spondylolisthesis according to the Spine Patient Outcomes Research Trial (SPORT) randomized controlled trial.[6] This may be cost-effective.[7]

Surgery may improve outcome at two years in patients with spondylolisthesis according to the Spine Patient Outcomes Research Trial (SPORT) randomized controlled trial.[8]

References

  1. Anonymous (2024), Spinal stenosis (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. Katz JN, Harris MB (February 2008). "Clinical practice. Lumbar spinal stenosis". N. Engl. J. Med. 358 (8): 818–25. DOI:10.1056/NEJMcp0708097. PMID 18287604. Research Blogging.
  3. Sugioka T, Hayashino Y, Konno S, Kikuchi S, Fukuhara S (August 2008). "Predictive value of self-reported patient information for the identification of lumbar spinal stenosis". Fam Pract 25 (4): 237–44. DOI:10.1093/fampra/cmn031. PMID 18552358. Research Blogging.
  4. Suri P, Rainville J, Kalichman L, Katz JN (2010). "Does this older adult with lower extremity pain have the clinical syndrome of lumbar spinal stenosis?". JAMA 304 (23): 2628-36. DOI:10.1001/jama.2010.1833. PMID 21156951. Research Blogging.
  5. Friedly JL, Comstock BA, Turner JA, Heagerty PJ, Deyo RA, Sullivan SD, et al. A Randomized Trial of Epidural Glucocorticoid Injections for Spinal Stenosis. New England Journal of Medicine. 2014;371(1):11–21. DOI:10.1056/NEJMoa1313265
  6. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B et al. (2008). "Surgical versus nonsurgical therapy for lumbar spinal stenosis.". N Engl J Med 358 (8): 794-810. DOI:10.1056/NEJMoa0707136. PMID 18287602. PMC PMC2576513. Research Blogging.
  7. Tosteson AN, Lurie JD, Tosteson TD, et al (December 2008). "Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis: cost-effectiveness after 2 years". Ann. Intern. Med. 149 (12): 845–53. PMID 19075203[e]
  8. Weinstein JN, Lurie JD, Tosteson TD, et al (2007). "Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis". N. Engl. J. Med. 356 (22): 2257–70. DOI:10.1056/NEJMoa070302. PMID 17538085. Research Blogging.