One of the most common problems encountered by rheumatologists is lumbar spinal stenosis. This is a condition where arthritis and disc disease in the low back narrows the central canal that the spinal cord occupies. As a result there is pressure placed on the spinal cord leading to many confusing symptoms.
Typically occurring in people past the age of 65, most will have back pain that radiates into the buttocks and upper thighs. The pain is worse with standing and walking and relieved by sitting. Patients will often exhibit a waddling gait and have an abnormal sensory exam during the physical.
MRI scanning can help confirm the diagnosis. Typically, the exam will show arthritis in the facet joints, bulging of the intervertebral discs, and enlargement of the ligamentum flavum, the thick ligament that runs lengthwise down the spinal canal.
Other conditions can make the diagnosis difficult. These include osteoarthritis of the hip, mechanical back pain, hip bursitis, and vascular narrowing. The latter also causes aching in the legs with walking. The difference can be made by having the patient ride a bike. With vascular claudication, the pain will return. With spinal stenosis, the pain will not.
Treatment is highly dependent on the individual patient. While exercise and non-steroidal anti-inflammatory drugs may relieve some symptoms, they are difficult for many older patients with spinal stenosis to tolerate. Epidural injections of steroids sometimes are helpful. Many patients will require decompression surgery.
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