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Spinal Stenosis Management Strategies

This document discusses the management of a patient presenting with bilateral leg pain that is likely due to a central spinal issue rather than a peripheral one given the bilateral presentation. Potential causes include spinal cord neoplasms or stenosis. Common lumbar stenosis findings include chronic low back pain, paraesthesia, and pain relieved by flexion. Differential diagnosis should consider involvement of the L5, S1, and S2 nerve roots and discs. Management includes conservative care with PRICE, avoidance of extension, massage, mobilization, medications, and rehabilitation focusing on core strengthening. Surgery may be an option if conservative care is ineffective.

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123 views4 pages

Spinal Stenosis Management Strategies

This document discusses the management of a patient presenting with bilateral leg pain that is likely due to a central spinal issue rather than a peripheral one given the bilateral presentation. Potential causes include spinal cord neoplasms or stenosis. Common lumbar stenosis findings include chronic low back pain, paraesthesia, and pain relieved by flexion. Differential diagnosis should consider involvement of the L5, S1, and S2 nerve roots and discs. Management includes conservative care with PRICE, avoidance of extension, massage, mobilization, medications, and rehabilitation focusing on core strengthening. Surgery may be an option if conservative care is ineffective.

Uploaded by

api-468093714
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Week 8 Category 2

• With an insidious onset, bilateral presentation such as this, what is the likelihood that this
would be a peripheral issue?
It is very uncommon for peripheral issues to present bilaterally, typically they occur
unilaterally. Generally, if the issue presents bilaterally the issue will be more central

• What neoplasms/malignancies would we consider in a patient of this age?


• Spinal cord neoplasms (astrocytoma's; glioma's, etc)
• Other visceral organs that refer pain (kidney; prostate; etc)

• List common findings, history for stenotic lumbar complaints


• Chronic LBP
• Paraesthesia
• Relieved with flexion or sitting
• Pain worse with extension

• What nerve roots and peripheral branches do you need to eliminate in this of potential of
buttock referral? Be specific about disc and IVF levels that could be involved.
• L5; S1; S2

Posterior osteophytes off vertebral


body & facet arthropy causing
spinal stenosis (narrowing of spinal
canal)
Central spinal canal stenosis

• How could you differentiate vascular claudication from neuro-claudication?


Neuro-claudication Vascular-claudication

Age Over 50 - long history of back ache Over 50

Type of pain Weakness, burning, numbing or tingling Cramping, aching, squeezing

Leg pain Proximal Distal

Back pain Yes Not usually

Onset Walking (uphill & downhill). Prolonged Walking a set distance each
standing time, especially uphill

Relief Lying down, flexing spine Standing still

Associations Bowel & bladder symptoms Impotence

Pulses Present Present (usually), reduced or


absent in some

Lumbar Aggravates No change


extension

Neurological Saddle distribution. Ankle reflex may be No change


changes reduced after some exercise
• What would be your management strategy for this case?
• PRICE when acute
• Avoiding lumbar extension
• Massage therapy - relaxation to spinal musculature
• Mobilisation/manipulations - flexion based adjustments
• Medication
o NSAID's
o Analgesics for acute flare up's
• Rehabilitation
o Stretch & strength training - improve core body strength

• What is your likelihood of success?


According to Johnsson et.al (1991), approx. 30% of patients improved with conservative
treatment

• How quickly would you expect to see improvement in this case?


The pain associated with spinal stenosis can improve with medication and conservative
treatment and rehabilitation. The time taken varies on the individual.

• What surgical options are available for these cases?


If surgery were required, a laminotomy or laminectomy would be performed. The goal of
surgery is to decompress the affected nerve roots.

1. Outline a management plan including a rehabilitation protocol for one of your serious MSK
differentials.
Conservative treatment
• PRICE when acute
• Avoiding lumbar extension
• Massage therapy - relaxation to spinal musculature
• Mobilisation/manipulations
o Flexion based adjustments
o Side-lying lumbar rotation thrust
o P-A mobilisations

• Medication
o NSAID's
o Analgesics for acute flare up's

• Rehabilitation during conservative treatment


o Lumbar isometric & stretching exercises
o Static & dynamic postural exercises
o Muscle strengthen - lumbar spine & core
o Flexion based exercises

• Single & double knee to chest in supine position

Surgery
May be necessary is conservative treatment is not effective. Aim is to decompress the affected
roots.

2. Demonstrate / Describe 3 exercises you could use for this patient to improve his leg
symptoms and strength the lumbopelvic area.

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