The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Ankylosing Spondylitis Resource Center
    • Gout Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Meet the Lumbar Spinal Stenosis Challenge

Meet the Lumbar Spinal Stenosis Challenge

August 1, 2007 • By David G. Borenstein, MD

  • Tweet
  • Email
Print-Friendly Version / Save PDF

The rapid reversibility of leg pain with a change in posture is strong evidence for the important role of vascular obstruction as a primary component of the pathogenesis of neurogenic claudication. The longer the duration of the vascular compromise, the more persistent and total becomes the neural dysfunction. The clinical correlate would be radicular pain followed by numbness and muscular weakness. Alleviation of vascular congestion can normalize the function of the sciatic nerve and diminish leg pain. Therefore, the goal of therapy is to maximize neural blood flow and restore nerve function.

You Might Also Like
  • ACR Makes Available Spinal Stenosis Fact Sheet
  • The Complexity of Lumbar Spinal Stenosis
  • Nonsurgical Management of Lumbar Spinal Stenosis
Explore This Issue
August 2007
Also By This Author
  • Advancing Rheumatology on Many Fronts

Clinical History

Neurogenic or pseudoclaudication is the most common symptom associated with spinal stenosis.6 Pain that is associated with standing or walking occurs in the buttock, thigh, or lower leg. The patterns of back and/or leg pain are as different as the patients who have the disorder. Most patients will complain of low back and leg pain. A smaller proportion will have leg pain alone. Many patients will have bilateral leg pain. The extent of the leg pain may be different in the extremities. Multiple dermatomes may be affected. The widespread distribution of symptoms makes it difficult to ascribe compression to a single nerve root lesion. In addition to pain, patients may also have numbness, paresthesias, and weakness in the lower extremities. Less commonly, similar symptoms can occur while patients are lying down and are relieved by getting out of bed. Neurogenic claudication is relieved by lying down, sitting, or flexing at the waist. Many elderly patients enjoy going to the grocery store so that they can flex over the shopping carts.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

Some of my most perplexing patients have been those with spinal stenosis. One was an executive with the chief complaint of medial knee pain. He wanted me to diagnose his problem so I could save his marriage. He had knee pain for about a year that was exacerbated by standing and relieved by sitting. He had been evaluated with knee radiographs and magnetic resonance (MR) demonstrating no abnormality. Knee braces and physical therapy were of no benefit. What did this have to do with his marriage? He could sit at his desk and play racquetball three times a week without pain, but could not dance more than a few minutes with his wife before he had to sit down. She suspected he did not love her anymore, but he did.

Of course, the problem was not in his knee, but in his lumbar spine. When the man played racquetball, he was in a flexed posture. When he danced, he was in an extended posture. An MR scan of the lumbar spine revealed his spinal stenosis. He received a course of nonsteroidal anti-inflammatory drugs (NSAIDs) and epidural corticosteroid injections with an excellent response. His marriage was saved!

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Pages: 1 2 3 4 5 6 7 8 | Single Page

Filed Under: Conditions, Spondyloarthritis Tagged With: Diagnostic Criteria, Pathogenesis, Spinal Stenosis, TreatmentIssue: August 2007

You Might Also Like:
  • ACR Makes Available Spinal Stenosis Fact Sheet
  • The Complexity of Lumbar Spinal Stenosis
  • Nonsurgical Management of Lumbar Spinal Stenosis
  • Reading Rheum: Lumbar Spinal Stenosis

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2021 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.