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Spinal stenosis

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High Yield Notes

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Flashcards

Spinal stenosis

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Questions

USMLE® Step 1 style questions USMLE

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A 35-year-old man comes to the clinic due to back pain. Upon entering the clinic, the patient is observed to be limping and appears in pain. He discloses back pain for the past few months that has been progressively worsening. Two days ago, he felt severe pain while lifting a box at home. The patient now describes the pain as dull, 7/10 in severity, which worsens with movement and radiates to the left thigh. He has noticed numbness in the perianal region while using the toilet. Vitals are within normal limits. On physical examination, focal tenderness is noticed over the lumbar and paraspinal area. There is a loss of sensation around the perianal area but a normal anal sphincter tone. Knee jerk reflex is normal but the ankle reflex is absent on the left. Strength is 5/5 on the right and 4/5 in the left gluteus maximus and hamstring muscles. Which of the following features will prompt the need for emergent imaging?

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Summary

Spinal stenosis is a medical condition in which there is an abnormal narrowing (stenosis) of the spinal canal, which may occur in any of the regions of the spine. This narrowing causes a restriction to the spinal canal, resulting in a neurological deficit. The most common cause of spinal stenosis is age-related changes in the spine, such as degenerative changes in the discs and bones that make up the spinal column. Other causes include arthritis, spinal tumors, and genetic conditions that affect the development of the spine.

Symptoms include pain, numbness, paraesthesia, and loss of motor control. The location of the stenosis determines which area of the body is affected. There are several types of spinal stenosis, with lumbar stenosis and cervical stenosis being the most frequent. While lumbar spinal stenosis is more common, cervical spinal stenosis is more dangerous because it involves compression of the spinal cord whereas lumbar spinal stenosis involves compression of the cauda equina. Treatment for spinal stenosis can include pain medications, physical therapy, and in more severe cases, surgery.