Lumbar Spinal Stenosis

Question 1

Stenosis

Answer 1

Narrowing of the spinal canal

Question 2

Which is most common: central canal stenosis or intervertebral foraminal stensosis?

Answer 2

Intervertebral Foraminal Stenosis

Question 3

Possible causes of Central Canal stenosis?

Answer 3

Potential spinal cord compression (significant central disc herniation) or possible Cauda Equina syndrome

Question 4

What is the cause of Intervertebral foraminal stenosis?

Answer 4

Spinal nerve root compression

Question 5

Which type of stenosis has a worse prognosis?

Answer 5

Central canal stenosis

Question 6

Lumbar spinal stenosis is caused by the degenerative aging process of what? And what can they all lead to?

Answer 6

Disc degeneration, Hypertrophy of facet joints, ligamentum flavum, Osteophytes, disc bulges; lead to less space for the nerve root in the spinal canal

Question 7

Lumbar stenosis elements from pt history: Age

Answer 7

> 50

Question 8

Lumbar stenosis elements from pt history: LBP and or LE symptoms with ________________

Answer 8

standing/walking

Question 9

Lumbar stenosis elements from pt history: relief with ______________

Answer 9

sitting

Question 10

Lumbar stenosis elements from pt history: improved walking tolerance with _____________

Answer 10

Flexion

Question 11

Lumbar stenosis elements from pt history: pain worse in _________ with __________ which _____________

Answer 11

AM; initial WB; improves throughout the day

Question 12

Lumbar stenosis common finding from Physical Exam: limited/painful _________________

Answer 12

lumbar extension AROM

Question 13

Lumbar stenosis common finding from Physical Exam: centralization with _____________ and peripheralization with _______________ (repeated movement testing)

Answer 13

Flexion; Extension

Question 14

Lumbar stenosis common finding from Physical Exam: tightness of _________________

Answer 14

hip flexors, hamstrings

Question 15

Lumbar stenosis common finding from Physical Exam: weakness of __________________

Answer 15

Hip extensors/Abductors

Question 16

Lumbar stenosis common finding from Physical Exam: May show + _______________ signs with Neuro exam

Answer 16

neurological compression

Question 17

Lumbar stenosis common finding from Physical Exam: discomfort with ______________

Answer 17

prone lying

Question 18

Lumbar stenosis common finding from Physical Exam: + _____________ of lumbar spine assessed with spring testing

Answer 18

Hypomobility

Question 19

Lumbar stenosis common finding from Physical Exam: Pain provocation with ________________

Answer 19

spring testing

Question 20

Lumbar stenosis common finding from Physical Exam: Limited ______ mobility, especially _________________

Answer 20

hip; Hip IR ROM

Question 21

What are the most common levels to test for lumbar stenosis symptoms due to the fact that over 95% of lumbar pathology happens at these levels?

Answer 21

L4/L5 and L5/S1

Question 22

S1 strength testing

Answer 22

Calf raises

Question 23

L5 strength testing

Answer 23

Great toe EXT

Question 24

L4/L5 strength testing

Answer 24

ankle dorsiflexion

Question 25

Many pts with stenosis have LE symptoms and difficulty walking due to compression of ________________ (neurogenic)

Answer 25

spinal nerves

Question 26

What disease can also present with LE symptoms, be aggravated with walking, and mimic neurogenic symptoms?

Answer 26

Peripheral Vascular Disease

Question 27

What is used to differentiate between Neurogenic and vascular symptoms?

Answer 27

Bicycle test

Question 28

Bicycle test

Answer 28

Pt rides stationary bike in upright position (lumbar spine extended) and then rides in flexed position (lumbar spine flexed)

Question 29

Interpretation of the bicycle test

Answer 29

If patient gets LE symptoms in both positions around the same time period or distance ridden = Vascular If patient get symptoms in extended position and does not get symptoms in flexed position or rides an increased distance before symptom onset = neurogenic

Question 30

Red Flags in the Lumbopelvic region

Answer 30

Cancer cluster, Cauda Equina Symptoms, and + UMN signs/pathological reflexes

Question 31

Cancer cluster

Answer 31

Age >50, previous history of cancer, unexplained weight loss, and failure to respond to conservative treatment

Question 32

+ UMN signs/pathological reflexes

Answer 32

Clonus, Babinski, and Hoffman's

Question 33

Lumbar spinal stenosis pts often fit into what treatment-based categories?

Answer 33

Specific Exercise - Flexion and Mobilization

Question 34

If a pt with lumbar spinal stenosis has symptoms that are consistently present distal to the knee, and have + signs of nerve root compression, they may often be placed in what treatment-based classification?

Answer 34

Traction

Question 35

Recommended Manual Therapy Interventions for Lumbar Stenosis

Answer 35

Manual lumbar traction, long-axis distraction, lumbar roll, lateral hip glide/specific directional hip mobs based on restrictions, hip flexor/hamstring/piriformis contract-relax stretching, and mobilizations to the thoracic spine to promote extension