Diagnosis of lumbar spinal stenosis

diagnosis

Diagnosis is usually made from a combination of clinical signs from the history, physical examination, and imaging.

• history
  • age
  • radiating leg pain that is exacerbated by standing up or walking
  • the absence of pain when seated
  • the improvement of symptoms when bending forward
  • a wide based gait
    
    
• physical examination
  • balance impairment
  • neuromuscular deficits in the lower extremities including decreased strength (weakness), sensory deficits (numbness), and absent or decreased reflexes (Achilles tendon and patellar)
  • tests used to assess functional capacity includes:
    • treadmill protocols
    • the gait loading test
    • the self paced walking test
      
      
• electrodiagnostics
  • methods including electromyography is not used routinely:
    • useful
      • when clinical picture and imaging results do not match
      • in differentiating the condition from diseases with a similar presentation e.g. - peripheral vascular disease (vascular claudication), hip osteoarthritis, and spinal cord lesions
        
        
• imaging
  • although imaging provides the most definitive diagnostic information, it is not carried out routinely during the initial evaluation.
    • usually reserved for diagnostic confirmation and procedure planning for patients considering invasive interventions Â
  • MRI
    • currently the recommended method for confirming the diagnosis of LSS
    • has a sensitivity of 87-96% and specificity of 68-75% for the diagnosis of LSS
  • CT
    • recommended when MRI is contraindicated or unavailable.

Note

• an estimated 21% of people with anatomic stenosis on MRI are asymptomatic. Hence history and clinical presentation should be considered together with imaging before a diagnosis is made

Reference:

• (1) Lurie J,Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ.2016;352:h6234.