Daily bolus of LR: Spinal Stenosis

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February 7, 2011 by dailybolusoflr

The classic features of spinal stenosis include:
·         Bilateral leg pain that is worse with prolonged standing or walking (termed pseudoclaudication) and with back extension
·         The pain is ameliorated by rest and lumbar flexion, which helps to decrease spinal cord tension by opening up the spinal canal
 
The diagnosis is confirmed by CT or MRI. 
 
Peripheral vascular disease can present similarly. 
·         It is important to differentiate pseudoclaudiation due to spinal stenosis (pain is due to neurologic compression) from vascular claudication due to peripheral vascular disease (pain is due to arterial compromise). 
·         This is done by checking ankle-brachial indices and peripheral pedal pulses, which are normal in spinal stenosis. 
·         In addition, vascular claudication will not be improved with lumbar flexion and may even increase in severity.
 
 
 
 
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions

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