Spinal stenosis: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
A [[clinical prediction rule]] exists to help diagnose spinal stenosis based on the history and physical.<ref name="pmid18552358">{{cite journal |author=Sugioka T, Hayashino Y, Konno S, Kikuchi S, Fukuhara S |title=Predictive value of self-reported patient information for the identification of lumbar spinal stenosis |journal=Fam Pract |volume=25 |issue=4 |pages=237–44 |year=2008 |month=August |pmid=18552358 |doi=10.1093/fampra/cmn031 |url=http://fampra.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18552358 |issn=}}</ref> | A [[clinical prediction rule]] exists to help diagnose spinal stenosis based on the history and physical.<ref name="pmid18552358">{{cite journal |author=Sugioka T, Hayashino Y, Konno S, Kikuchi S, Fukuhara S |title=Predictive value of self-reported patient information for the identification of lumbar spinal stenosis |journal=Fam Pract |volume=25 |issue=4 |pages=237–44 |year=2008 |month=August |pmid=18552358 |doi=10.1093/fampra/cmn031 |url=http://fampra.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=18552358 |issn=}}</ref> | ||
According to a [[systematic review]] by the [[Rational Clinical Examination]]: <ref name="pmid21156951">{{cite journal| author=Suri P, Rainville J, Kalichman L, Katz JN| title=Does this older adult with lower extremity pain have the clinical syndrome of lumbar spinal stenosis? | journal=JAMA | year= 2010 | volume= 304 | issue= 23 | pages= 2628-36 | pmid=21156951 | doi=10.1001/jama.2010.1833 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21156951 }} </ref> | |||
The most useful symptoms for increasing the likelihood of spinal stenosis are: | |||
* Having no pain when seated (LR, 7.4; 95% CI, 1.9-30) | |||
* Improvement of symptoms when bending forward (LR, 6.4; 95% CI, 4.1-9.9) | |||
* Bilateral buttock or leg pain (LR, 6.3; 95% CI, 3.1-13) | |||
* Neurogenic claudication (LR, 3.7; 95% CI, 2.9-4.8) | |||
The most useful symptoms for decreasing the likelihood of spinal stenosis are: | |||
* Absence of neurogenic claudication (LR, 0.23; 95% CI, 0.17-0.31) | |||
==Treatment== | ==Treatment== | ||
Revision as of 10:47, 27 December 2010
Spinal stenosis is "narrowing of the spinal canal."[1][2] Spinal stenosis is a cause of low back pain.
Cause/etiology
One cause is spondylolisthesis.
Diagnosis
A clinical prediction rule exists to help diagnose spinal stenosis based on the history and physical.[3]
According to a systematic review by the Rational Clinical Examination: [4] The most useful symptoms for increasing the likelihood of spinal stenosis are:
- Having no pain when seated (LR, 7.4; 95% CI, 1.9-30)
- Improvement of symptoms when bending forward (LR, 6.4; 95% CI, 4.1-9.9)
- Bilateral buttock or leg pain (LR, 6.3; 95% CI, 3.1-13)
- Neurogenic claudication (LR, 3.7; 95% CI, 2.9-4.8)
The most useful symptoms for decreasing the likelihood of spinal stenosis are:
- Absence of neurogenic claudication (LR, 0.23; 95% CI, 0.17-0.31)
Treatment
Surgery may improve outcome at two years in patients with spinal stenosis not from spondylolisthesis according to the Spine Patient Outcomes Research Trial (SPORT) randomized controlled trial.[5] This may be cost-effective.[6]
Surgery may improve outcome at two years in patients with spondylolisthesis according to the Spine Patient Outcomes Research Trial (SPORT) randomized controlled trial.[7]
References
- ↑ Anonymous (2024), Spinal stenosis (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Katz JN, Harris MB (February 2008). "Clinical practice. Lumbar spinal stenosis". N. Engl. J. Med. 358 (8): 818–25. DOI:10.1056/NEJMcp0708097. PMID 18287604. Research Blogging.
- ↑ Sugioka T, Hayashino Y, Konno S, Kikuchi S, Fukuhara S (August 2008). "Predictive value of self-reported patient information for the identification of lumbar spinal stenosis". Fam Pract 25 (4): 237–44. DOI:10.1093/fampra/cmn031. PMID 18552358. Research Blogging.
- ↑ Suri P, Rainville J, Kalichman L, Katz JN (2010). "Does this older adult with lower extremity pain have the clinical syndrome of lumbar spinal stenosis?". JAMA 304 (23): 2628-36. DOI:10.1001/jama.2010.1833. PMID 21156951. Research Blogging.
- ↑ Weinstein, J. N., Tosteson, T. D., Lurie, J. D., Tosteson, A. N., Blood, E., Hanscom, B., et al. (2008). Surgical versus nonsurgical therapy for lumbar spinal stenosis, N Engl J Med, 358(8), 794-810. {{doi:10.1056/NEJMoa0707136}}.
- ↑ Tosteson AN, Lurie JD, Tosteson TD, et al (December 2008). "Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis: cost-effectiveness after 2 years". Ann. Intern. Med. 149 (12): 845–53. PMID 19075203. [e]
- ↑ Weinstein JN, Lurie JD, Tosteson TD, et al (2007). "Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis". N. Engl. J. Med. 356 (22): 2257–70. DOI:10.1056/NEJMoa070302. PMID 17538085. Research Blogging.