Spinal Stenosis and Claudication

Narrowing of the central spinal canal, intervertebral foramen and/or lateral recess causing progressive nerve root compression

Aetiology

  • Mainly caused by degenerative joint disease in middle aged to eldery individuals
  • With spondylosis and a combination of bulging discs, bulging ligamentum flavum and osteophytosis, the cauda equina of the lumbar spine has less space

Clinical presentation

  • Generally patients over 60
  • Claudication (pain in legs on walking)

In constrast to vascular claudication (from PVD):

  • The claudication distance is inconsistent
  • The pain is burning (rather than cramping)
  • Spinal extension (standing or walking downhill) exacerbates symptoms while back flexion (sitting or walking uphill) improves symptoms
    • Spine flexion creates more space for the cauda equina
  • Pedal pulses are preserved

Investigations

  • Clinical diagnosis

Management

  • Conservative management - analgesia, physiotherapy, weight loss if indicated
  • If symptoms fail to resolve with conservative management and there is MRI evidence of stenosis, surgery may be performed (decompression to increase space for the cauda equina) to help alleviate symptoms