Spinal stenosis: Difference between revisions
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Spinal stenosis is "narrowing of the spinal canal."<ref>{{MeSH}}</ref> Spinal stenosis is a cause of [[lumbalgia|low back pain]]. | Spinal stenosis is "narrowing of the spinal canal."<ref>{{MeSH}}</ref><ref name="pmid18287604">{{cite journal |author=Katz JN, Harris MB |title=Clinical practice. Lumbar spinal stenosis |journal=N. Engl. J. Med. |volume=358 |issue=8 |pages=818–25 |year=2008 |month=February |pmid=18287604 |doi=10.1056/NEJMcp0708097 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=18287604&promo=ONFLNS19 |issn=}}</ref> Spinal stenosis is a cause of [[lumbalgia|low back pain]]. | ||
==Cause/etiology== | ==Cause/etiology== | ||
One cause is [[spondylolisthesis]]. | One cause is [[spondylolisthesis]]. | ||
==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> | |||
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== | ||
===Steroid injections=== | |||
According to a [[randomized controlled trial]], steroid injections do not provide meaningful benefit.<ref>Friedly JL, Comstock BA, Turner JA, Heagerty PJ, Deyo RA, Sullivan SD, et al. [http://www.nejm.org/doi/full/10.1056/NEJMoa1313265 A Randomized Trial of Epidural Glucocorticoid Injections for Spinal Stenosis]. New England Journal of Medicine. 2014;371(1):11–21. {{doi|10.1056/NEJMoa1313265}}</ref> | |||
</ref> | ===Surgery=== | ||
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]].<ref name="pmid18287602">{{cite journal| author=Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B et al.| title=Surgical versus nonsurgical therapy for lumbar spinal stenosis. | journal=N Engl J Med | year= 2008 | volume= 358 | issue= 8 | pages= 794-810 | pmid=18287602 | doi=10.1056/NEJMoa0707136 | pmc=PMC2576513 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18287602 }} </ref> This may be cost-effective.<ref name="pmid19075203">{{cite journal |author=Tosteson AN, Lurie JD, Tosteson TD, ''et al'' |title=Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis: cost-effectiveness after 2 years |journal=Ann. Intern. Med. |volume=149 |issue=12 |pages=845–53 |year=2008 |month=December |pmid=19075203 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=19075203 |issn=}}</ref> | |||
Surgery may improve outcome at two years in patients ''with'' spondylolisthesis according to the Spine Patient Outcomes Research Trial (SPORT) [[randomized controlled trial]].<ref name="pmid17538085">{{cite journal |author=Weinstein JN, Lurie JD, Tosteson TD, ''et al'' |title=Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis |journal=N. Engl. J. Med. |volume=356 |issue=22 |pages=2257–70 |year=2007 |pmid=17538085 |doi=10.1056/NEJMoa070302 |issn=}}</ref> | Surgery may improve outcome at two years in patients ''with'' spondylolisthesis according to the Spine Patient Outcomes Research Trial (SPORT) [[randomized controlled trial]].<ref name="pmid17538085">{{cite journal |author=Weinstein JN, Lurie JD, Tosteson TD, ''et al'' |title=Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis |journal=N. Engl. J. Med. |volume=356 |issue=22 |pages=2257–70 |year=2007|url=http://content.nejm.org/cgi/content/full/356/22/2257 |pmid=17538085 |doi=10.1056/NEJMoa070302 |issn=}}</ref> | ||
==References== | ==References== | ||
<references/> | <references/> | ||
Latest revision as of 03:36, 3 July 2014
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
Steroid injections
According to a randomized controlled trial, steroid injections do not provide meaningful benefit.[5]
Surgery
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.[6] This may be cost-effective.[7]
Surgery may improve outcome at two years in patients with spondylolisthesis according to the Spine Patient Outcomes Research Trial (SPORT) randomized controlled trial.[8]
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.
- ↑ Friedly JL, Comstock BA, Turner JA, Heagerty PJ, Deyo RA, Sullivan SD, et al. A Randomized Trial of Epidural Glucocorticoid Injections for Spinal Stenosis. New England Journal of Medicine. 2014;371(1):11–21. DOI:10.1056/NEJMoa1313265
- ↑ Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, 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. PMID 18287602. PMC PMC2576513. Research Blogging.
- ↑ 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.