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Spinal stenosis: Diagnosis

Etiology: Degeneration of the nucleus pulposis and reduction of disk height over time leading to osteophyte formation which can then cause progressive narrowing of the intervertebral foramina and spinal canal.

Definition: When osteophyte formations compress multiple nerve roots and cause bilateral pain and/or encroach on the cauda equina.

Symptoms: Back pain that usually radiates into both buttocks, thighs, and legs. Usually worse with exercise and relieved by rest, particularly sitting with the spine flexed or bending over a grocery cart.

Diagnosis: suggested by clinical symptoms however it is confirmed by MRI, CT or both of the spine with myelography. To assess for neurological compromise, EMG’s and SSEP’s can be useful.

Treatment: Mild-Moderate Stenosis with radicular symptoms: epidural steroids may be of some benefit Severe Symptoms: indication for surgical decompression.