Narrowing of the central spinal canal, intervertebral foramen and/or lateral recess causing progressive nerve root compression

Aetiology

• Mainly caused by degenerative joint disease in middle aged to elderly individuals
• With spondylosis and a combination of bulging discs, bulging ligamentum flavum and osteophytosis, the cauda equina of the lumbar spine has less space

Clinical features

• Generally patients over 60
• Claudication (pain in legs on walking)

In contrast to vascular claudication (from PVD):

• The claudication distance is inconsistent
• The pain is burning (rather than cramping)
• Spinal extension (standing or walking downhill) exacerbates symptoms while back flexion (sitting or walking uphill) improves symptoms
  • Spine flexion creates more space for the cauda equina
• Pedal pulses are preserved

Investigations

• Clinical diagnosis

Management

• Conservative management - analgesia, physiotherapy, weight loss if indicated
• If symptoms fail to resolve with conservative management and there is MRI evidence of stenosis, surgery may be performed (decompression to increase space for the cauda equina) to help alleviate symptoms