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Musculoskeletal - Spinal Stenosis
In this episode, we review lumbar spinal stenosis, a common degenerative condition characterized by narrowing of the spinal canal or neural foramina that compresses nerve roots of the cauda equina. We discuss the pathophysiology of age-related spinal changes—including disk degeneration, facet hypertrophy, ligamentum flavum thickening, and spondylolisthesis—that contribute to canal narrowing. The episode highlights the classic clinical presentation of neurogenic claudication, including leg pain with walking or standing that improves with sitting or forward flexion, often referred to as the "shopping cart sign." We also review key exam findings, diagnostic imaging with MRI, important differential diagnoses such as vascular claudication, and treatment strategies ranging from conservative therapy and physical therapy to decompressive laminectomy in refractory cases.
References
- Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
- Katz JN, Zimmerman ZE, Mass H, Makhni MC. Diagnosis and Management of Lumbar Spinal Stenosis: A Review. JAMA. 2022;327(17):1688–1699. doi:10.1001/jama.2022.5921
- Webb CW, Aguirre K, Seidenberg PH. Lumbar Spinal Stenosis: Diagnosis and Management. Am Fam Physician. 2024 Apr;109(4):350-359. PMID: 38648834.
- Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M; Lancet Low Back Pain Series Working Group. What low back pain is and why we need to pay attention. Lancet. 2018 Jun 9;391(10137):2356-2367. doi: 10.1016/S0140-6736(18)30480-X. Epub 2018 Mar 21. PMID: 29573870.
- Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP. Low back pain. Lancet. 2021 Jul 3;398(10294):78-92. doi: 10.1016/S0140-6736(21)00733-9. Epub 2021 Jun 8. PMID: 34115979.
View all episodes
By Kristopher Maday, PA-C, DFAAPAIn this episode, we review lumbar spinal stenosis, a common degenerative condition characterized by narrowing of the spinal canal or neural foramina that compresses nerve roots of the cauda equina. We discuss the pathophysiology of age-related spinal changes—including disk degeneration, facet hypertrophy, ligamentum flavum thickening, and spondylolisthesis—that contribute to canal narrowing. The episode highlights the classic clinical presentation of neurogenic claudication, including leg pain with walking or standing that improves with sitting or forward flexion, often referred to as the "shopping cart sign." We also review key exam findings, diagnostic imaging with MRI, important differential diagnoses such as vascular claudication, and treatment strategies ranging from conservative therapy and physical therapy to decompressive laminectomy in refractory cases.
References
- Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
- Katz JN, Zimmerman ZE, Mass H, Makhni MC. Diagnosis and Management of Lumbar Spinal Stenosis: A Review. JAMA. 2022;327(17):1688–1699. doi:10.1001/jama.2022.5921
- Webb CW, Aguirre K, Seidenberg PH. Lumbar Spinal Stenosis: Diagnosis and Management. Am Fam Physician. 2024 Apr;109(4):350-359. PMID: 38648834.
- Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M; Lancet Low Back Pain Series Working Group. What low back pain is and why we need to pay attention. Lancet. 2018 Jun 9;391(10137):2356-2367. doi: 10.1016/S0140-6736(18)30480-X. Epub 2018 Mar 21. PMID: 29573870.
- Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP. Low back pain. Lancet. 2021 Jul 3;398(10294):78-92. doi: 10.1016/S0140-6736(21)00733-9. Epub 2021 Jun 8. PMID: 34115979.