Spinal stenosis

1. When does spinal stenosis usually present? What is the most common level of involvement?
2. What is the difference between central and lateral stenosis?
3. What is the presentation of spinal stenosis? How is it differentiated from vascular claudication?
4. What diagnostic studies are used?
5. What is the treatment of spinal stenosis?

Answers:
1. Presents at 50 years are older. Most common levels are L3 and L4.
2. Central stenosis decreases the size of the vertebral canal secondary to hypertrophic facets, LF, disc encroachment, or degen spondylolisthesis. The spinal cord is 10 mm and there is neurologic sequelae with canal < 12mm (17mm is nl). Lateral stenosis can occur either in the lateral recess, mid-zone, or intervertebral foramen.
3. Neck or back discomfort, possible upper or lower limb involvement, neurogenic claudication (aching pain in leg with standing or walking, relieved with sitting or leaning forward). If claudication is vascular, the pain is more cramping, worse with uphill walking, better with downhill, better with standing, resting, or lying flat.
4. X-rays, CT, myelogram, MRI.
5. Relative rest, medications, rehab focusing on flexion or neutral based positioning and spinal stabilization, ESI. Surgery may be considered for decompression or stabilization.