CASE REPORTS
AN ELDERLY WOMAN WITH INTERMITTENT CLAUDICATION
In spinal stenosis the abnormal narrowing of the spinal canal can be produced by various causes, e.g. congenitally short pedicles, progressive bony encroachment from lumbar spondylosis (osteophytes), thickening of ligamentum flavum, protrusion of intervertebral disc, spondylolisthesis, etc. Compression of the microvasculature of the lumbar nerve roots before they exit from the neural foramen is believed to be a major contributing factor in the development of neurogenic claudication.
Imaging
Imaging with lumbosacral spine radiographs may show degenerative changes like spondylolisthesis, disc degeneration and disc height lost with osteophytes formation. However, MRI is now the imaging modality of choice. It is important to correlate the MRI findings with the clinical findings as on MRI is too sensitive, showing signs with few symptoms, as in the patient above. On MRI she had degenerated disc changes, which appeared black on T2 weighted images with prolapse at most of lumbar vertebral levels, with hypertrophied (thickened) facet joints and ligamentum flavum but she is symptomatic only from changes at L4/5 and L5/S1as shown in the Figures.
Treatment
According to the severity of stenosis, our patient belongs to the mild type and responded well to conservative treatment thus avoiding major spine surgery in a possibly high-risk patient. In the event that her symptoms get worse and affect her activities of daily living then one can explain and suggest to her and her family about lumbar spinal decompression surgery (with or without fusion and instrumentation).3
CONCLUSION
This case illustrates the importance of a good history (especially about aggravating and relieving factors of leg symptoms) and careful physical examination in an elderly patient presenting with back and leg pain. Here I also recommend a trial of conservative treatment, judicious use of non-steroidal anti-inflammatory drugs and physical therapy before embarking on any major spine operation in elderly patients.
REFERENCES
- Alvarez JA, Hardy RH Jr. Lumbar spine stenosis: a common cause of back and leg pain. Am Fam Physician. 1998 Apr 15;57(8):1825-34, 1839-40 [PubMed] [Full text]
- Dyck P, Doyle JP Jr. “Bicylcle test” of van Gelderen in diagnosis of intermittent cauda equina compression syndrome. Case report. J Neurosurg. 1977 May;46(5):667-70 [PubMed]
- Snyder DL, Doggett D, Turkelson C. Treatment of degenerative lumbar spinal stenosis. Am Fam Physician. 2004 Aug 1;70(3):517-20 [PubMed] [Full text]
<< Page 1 | 2 >>