CC March 2016 Lumbar Spinal Stenosis

echoecho's version from 2016-04-26 05:47


Question Answer
Lumbar spinal stenosis (LSS) is a common condition affecting what type of patients? What gender has this more? 1) older patients 2) female
What patient types are at higher risk of having LSS (which may account for a rising incidence)?obese and overweight patients
LSS can be what two type of categories?1) congenital 2) more frequently acquired secondary to degenerative changes in the spine
Describe the natural progression of this disorder?small studies suggest that 70% of untreated individuals remain unchanged after 4 years, with 15% worsening and 15% improving
Symptoms of LSS are variable, depending on what?the part of the spine that is affected
What is the most common presentation?leg pain (halmark neurogenic claudication or less commonly, radicular leg pain
What are the signs / symptoms of neurogenic claudication?1) pain 2) heaviness 3) numbness 4) cramping 5) burning or weakness that is either bilateral or unilateral 6) occurs with activity, typically walking and generally does not follow a dermatomal pattern
_____ of the spine will exacerbate symptoms and _____ will provide relief?Extension; flexion
Patients often describe a specific distance they can walk before the symptoms occur, hence the comparison to ______ claudication?vascular
What do patients do to alleviate the pain?lean forward or squat (which flexes the trunk)
Older people with LSS often lean _____ on grocery carts when walking?forward
What 3 activities is less painful?riding a bike, walking uphill, driving
Because of stenosis can compress the nerves or cord, what changes may develop? Specifically what symptoms?1) bladder and bowel function changes 2) urgency, frequency and loss of control
Are physical findings in LSS consistent?no they are inconsistent
Which physical tests are usually normal, as is a general neurological exam?striaght leg raising and femoral nerve stretching tests
What could you have the patient do to bring out objective signs?having patient walk until pain occurs
List the differential diagnoses?1) DJD 2) disc degeneration 3) rheumatoid arthritis 4) infections 5) spondylolisthesis 6) fractures 7) Paget's disease 8) neoplasms 9) peripheral neuropathy 10) endocrinopathies (Cushing disease or acromegaly) 11) anklylosing spondylitis 12) previous back surgery
Differentiating vascular and neurogenic claudication is important, but can they occasionally co-exist?yes
Older adults with spinal stenosis rated problems related to _____ and _____ function as the outcomes most important to them, Because of this, therapy should be directed at what?1) pain; physical 2) improving quality of life and monitoring for relatively rare complications such as cauda equina syndrome
What type of therapy is often effective in the short-term and may include what modalities?1) conservative 2) analgesics (acetaminophen, NSAIDs) 3) physical therapy 4) manipulative therapy 5) acupuncture
*** A 2013 Cochrane review found no good eivdence of the efficacy of what treatment of LSS and thus was unable to provide recommendations to guide clinical practice?non-operative treatments
A systematic review and meta-analysis found that what treatment modality or combined anesthetic/corticosteroids are effective for short-term relief, but evidence is lacking for ____-______ benefit?1) epidural infections with anesthetic agents
A double-blind, randomized, controlled trial found nonsignificant improvements in the steroid injection group at ___ weeks with no difference at ___ weeks?3; 6
Opioid use should be severely limited due to what?chronic nature of the disorder and risk of dependency
List other pharmacologic agents used however have significant medication side effects and may contribute to increased falls? 1) pregabalin (Lyrica) 2) gabapentin (Neurotin), 3) tricyclic antidepressants
Comment on TENS (transdermal electrical nerve stimulation) as to the effectiveness of this modality, or that of corsets, heat application or traction?failed to provide sufficient evidence for effectiveness
LSS has become the most common indication for what surgery? Is there good evidence for relatively prolonged benefit?1) spine 2) yes
*** At 1-4 years' follow-up, surgical outcomes were better than conservative therapy for radicular and lower back pain. What were the findings at 10 year followup?there was no significant difference for low back pain but surgery remained more beneficial for radicular pain
What imaging study is inexpensive and may help r/o other spine pathologies?plain x-ray
*** What imaging study is the most appropriate noninvasive test to conform the presence of anatomic narrowing of the spinal canal or the presence of nerve root impingement?MRI
Where MRI is contraindicated, what should be considered?1) CT 2) including CT myelography
*** SUMMARY = What is the hallmark presentation of lumbar spinal stenosis?neurogenic claudication (pain numbness and weakness does NOT follow a dermatomal pattern
*** SUMMARY = Conservative therapy is often effective in the short term and include what modalities?1) analgesics (acetaminophen, NSAIDS), physical therapy, manipulative therapy and acupuncture
*** SUMMRY = LSS has become the most common indication of what surgery and good evidence exists for relatively prolonged benefit?spine surgery