Degenerative Spinal Stenosis (DSS)

Authors

Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Degenerative spinal stenosis (DSS) refers to a narrowing of the spinal canal (central), nerve root canal (lateral recess), or intervertebral foramen (foraminal stenosis) of the lumbar spine due to chronic degeneration of tissue¹. This narrowing can in the compression of the neural and vascular structures¹.

Since DSS is due to chronic degeneration, rates increase with older age¹.

Claudication

Claudication refers to a compression and occlusion of the arteries or veins running through the canal¹. Long term claudication can result in nerve root ischemia and resulting in symptoms¹.

Neurogenic claudication

Neurogenic claudication or “pseudoclaudication” refers to physical impingement of the nerve root¹.

Compressive loading of the spine can also exacerbate symptoms, such as those that occur with prolonged standing. Central stenosis, which can result in symptoms related to cauda equina compression, may occur more often with certain movements or changes in posture:

Aggs & Eases

Often, walking is aggravating when someone has nerve root ischemia or claudication and those symptoms are relieved by sitting¹.

Compressive load to the spine can aggravate symptoms¹. A common example is prolonged standing¹.

• Postures with lumbar lordosis can be aggravating since lordosis shortens the length of the canal¹.
• Lumbar extension narrows the canal¹.
• Sidebending narrows the canal, but to not as signficantly as extension¹.

Eases

Lumbar flexion is an easing factor since it opens the canal and increases arterial blood flow and venous capacity¹.

Symptoms

Central stenosis can result in compression of the cauda equina, resulting in a constellation of cauda equina symptoms¹.

Presentation

Most LSS patients have:

• Reduced hip flexor flexibility, especially iliopsoas and rectus femoris¹. The hip extensor muscles (gluteus maximus and hamstrings) usually are lengthened.

Examination

History

Symptomatic LSS patients typically have a long history of LBP¹. The primary symptom is generally unilateral or bilateral leg pain¹.

DDX

Treatment

• Lumbar thrust, nerve mobilization, and exercise resulted in minimally clinically important differences¹

my ideas:

• Assess limitations of other joints resulting in excessive lumbar spine mobility and load
  • Upper body: Thoracic spine, shoulders
  • Lower body: Hips
• Avoid excessive lumbar extension
  • Work on segmental spinal extensors
    • Spinal wave / Cat-cows
    • Lumbar reversals
    • seated jeffersons
    • horizontal cable RDLs
• Neurodynamic mobility
  • Sciatic nerve glides
• Detone hip flexors
  • prevent or reduce anterior translation (shearing) of upper L/s
• Trunk stability
  • Intraabdominal pressure
• Functional training
  • Perform movement observation of patient’s main functional goals
• Core training -chloe

References

1.

Dutton M. Dutton’s Orthopaedic Examination, Evaluation, and Intervention. 5th ed. McGraw Hill Education; 2020.