Spinal stenosis: The Daily PANCE Blueprint
A 68-year-old male reports bilateral leg pain that worsens when walking downhill and standing for long periods, but improves when he leans forward on a shopping cart. He also notes occasional numbness in his calves. Which of the following is the most likely diagnosis?
A. Lumbar spinal stenosis
B. Peripheral arterial disease
C. Sciatica from lumbar disc herniation
D. Diabetic neuropathy
E. Lumbar spondylolisthesis
Answer and topic summary
The answer is A. Lumbar spinal stenosis
Lumbar spinal stenosis is a condition that refers to either narrowing of the central canal, lateral recess, or neural foramen. Risk factors include obesity and family history. The most common cause is spondylosis or degenerative arthritis. Age of onset is > 60 years. The classic clinical feature is neurogenic claudication (ie leg pain worsening with walking/standing and relieved when lying or sitting). These patients often feel better when they are going uphill or leaning forward. Other possible symptoms that patients may have include discomfort, sensory loss, leg weakness, etc. MRI is the imaging modality of choice for diagnosis. Management is typically conservative measures (e.g., PT, anti-inflammatory medications, steroid injections, etc). Surgery should be a thoughtful intervention and is considered in those with severe neurological deficits.
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