Lumbar Spinal Stenosis

History

  1. Key point in history:
    • Differentiate between vascular and neurogenic stenosis.
    • Ask about walking distance and difficulty walking, onset and progression of symptoms.

Look

  1. Stooped posture:
    • Observe for a kyphotic or flexed posture, especially when standing.
  2. Elderly:
    • Note the age of the patient.
  3. Scars over the back:
    • Check for previous surgical scars which might indicate a history of back surgery.

Feel

  1. Pain over lower back:
    • Assess for localized or radicular pain in the lumbar area.

Move

  1. Restricted Range of Motion (ROM):
    • Look for limited forward bending, extension, and lateral bending.
  2. Gait:
    • Observe for a stooped, shuffling gait with a slow cadence.
    • The patient may walk with minimal movement to avoid symptoms.
  3. Lie Down
    • Perform a full neurologic examination to assess for any abnormalities.
    • Ask the patient to perform a bicycle test (exaggerated lumbar extension while sitting on a stationary bike). Pain relief in this position suggests neurogenic claudication.

Finishing

  1. PR (Per Rectum) and perianal sensation:
    • Perform to assess for sacral root involvement.
  2. Vascular examination:
    • Check pulses in the legs, for color changes, and for any signs of peripheral vascular disease.
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