diagnosis of lumbar spinal stenosis

Last edited 10/2020 and last reviewed 10/2020

diagnosis

Diagnosis is usually made from a combination of clinical signs from the history, physical examination, and imaging.

• history
• age
• radiating leg pain that is exacerbated by standing up or walking
• the absence of pain when seated
• the improvement of symptoms when bending forward
• a wide based gait
  
  
• physical examination
• balance impairment
• neuromuscular deficits in the lower extremities including decreased strength (weakness), sensory deficits (numbness), and absent or decreased reflexes (Achilles tendon and patellar)
• tests used to assess functional capacity includes:
• treadmill protocols
• the gait loading test
• the self paced walking test
  
  
• electrodiagnostics
• methods including electromyography is not used routinely:
  • useful
    • when clinical picture and imaging results do not match
    • in differentiating the condition from diseases with a similar presentation e.g. - peripheral vascular disease (vascular claudication), hip osteoarthritis, and spinal cord lesions
      
      
• imaging
• although imaging provides the most definitive diagnostic information, it is not carried out routinely during the initial evaluation.
• usually reserved for diagnostic confirmation and procedure planning for patients considering invasive interventions  
• MRI
• currently the recommended method for confirming the diagnosis of LSS
• has a sensitivity of 87-96% and specificity of 68-75% for the diagnosis of LSS
• CT
• recommended when MRI is contraindicated or unavailable.

Note

• an estimated 21% of people with anatomic stenosis on MRI are asymptomatic. Hence history and clinical presentation should be considered together with imaging before a diagnosis is made

Reference:

• (1) Lurie J,Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ.2016;352:h6234.