Stenosis

Pathophysiology

Spinal stenosis generally occurs in those aged over 50 years as a result of osteoarthritic change to the vertebrae and decreased disc height causing a narrowing of the spinal canal. This narrowing can then irritate the nerves passing around it and cause symptoms such as numbness, tingling and weakness.

Symptoms

• Leg pain and weakness in the legs, may also have numbness or pins and needles in the legs

• Can be one leg or both

• Symptoms worse with prolonged walking or standing

• Symptoms usually relieved by sitting or bending forwards

Management

• Activity modification and pacing

• Ice or heat

• Pain relief- in discussion with GP may be able to consider antineuropathic medication such as amitriptyline or gabape ntin

• Physiotherapy including range of movement exercises and a graded strengthening programme

• Orthopaedic of surgery if unresolving- likely to improve buttock and leg pain but may not improve low back pain

Investigations

MRI may be appropriate if symptoms do not improve with conservative measures after 3-6 months if wishes to consider surgery