Canal Stenosis vs HNP

Lumbar Spinal Stenosis vs HNP in Diagnose : History Taking

and Physical Examintation

Bayu Antara Hadi,dr.

Lumbar spinal stenosis
• Lumbar spinal stenosis is defined as a narrowing of the central
spinal canal and/or the intervertebral foramen most often caused
by degenerative changes.1
• As a result of LSS, the space available for the neural structures
within the central spinal canal or intervertebral foramen becomes
compromised, and neurogenic claudication may result.1
• The symptoms are insidious, presenting in the sixth or seventh
decade. There may be a long history of low back pain but the leg
symptoms lead to presentation.2

1Creighton, DS, Krauss,J, Marcoux,B.2006. Management of Lumbar Spinal Stenosis through the Use of
Translatoric Manipulation and Lumbar Flexion Exercises: A Case Series. The Journal of Manual &
Manipulative Therapy Vol. 14 No. 1 (2006), E1 - E10.
2Marshall,RW, Rajagopal,TS.2010. Understanding and treating spinal stenosis. The Journal of Bone and

Joit Surgery.
 Clinical studies have suggested that symptoms associated
with LSS are posture-dependent.1
 Lumbar extension narrows the central spinal canal and
intervertebral foramen, and it results in venous congestion.1
 Lumbar flexion may reduce anatomical encroachment by
changing the bony positional relationships and by opening
up the central canal and intervertebral foramen, thus
relieving circulatory congestion.1

1 Creighton, DS, Krauss,J, Marcoux,B.2006. Management of Lumbar Spinal Stenosis through the Use of
Translatoric Manipulation and Lumbar Flexion Exercises: A Case Series. The Journal of Manual &
Manipulative Therapy Vol. 14 No. 1 (2006), E1 - E10.
 The cardinal symptom is neurogenic claudication which
presents as numbness, weakness or discomfort in the legs;
this may come on with walking or prolonged standing and is
relieved by sitting or rest.2
 Typical symptoms of spinal stenosis (neurogenic
claudication) include pain, numbness, and paresthesias in the
posterolateral aspects of the thighs and legs. These
symptoms usually radiate distally and are aggravated by
prolonged walking or standing. 3

2Marshall,RW, Rajagopal,TS.2010. Understanding and treating spinal stenosis. The Journal of Bone and
Joit Surgery.
3Yuan,PS, Albert,TJ, 2004, Non Surgical and Surgical Management of Lumbar Spine Stenosis. The Journal

of Bone and Joint Surgery Vol. 86-A · Number 10

2
Marshall,RW, Rajagopal,TS.2010. Understanding and treating spinal stenosis. The Journal of Bone
and Joit Surgery.
4
Tomita,K.2003.Diagnosis andd Treatment of Lumbar Canal Stenosis. The Journal of the Japan Medical
Association 46(10): 439–444, 2003
• Physical findings are limited. The diagnosis is made from
the history and confirmed with imaging. 2
• There may be limitation of lumbar spinal extension,
sensory deficit, muscle weakness, limited straight leg raise,
absent knee reflexes and absent ankle reflexes.2

2 Marshall,RW, Rajagopal,TS.2010. Understanding and treating spinal stenosis. The Journal of Bone and
Joit Surgery.
HNP
• Occurs approximately 95% of the time at the L4-L5 or L5-
S1 level.5
• Peak incidence of HNP is between 30 and 55 years of age. 6
• The classic symptoms of lumbar HNP include low back
pain that worsens in the sitting position, and radiating pain
to a lower extremity.6

5Fisher, C., Noonan, V., Bishop, P., Boyd, M., Fairholm, D., Wing, P., et al. (2004). Outcome evaluation
of the operative management of lumbar disc herniation causing sciatica. Journal of Neurosurgery,
100, 317–324.
6Atlas, S., Keller, R., Chang, Y., Deyo, R., & Singer, D. (2001). Surgical and nonsurgical management of

sciatica secondary to a lumbar disc herniation. Spine, 26, 1179–1187.

  The pain associated with lumbar radiculopathy occurs due
to a combination of nerve root ischemia and inflammation
resulting from local pressure and neurochemical
inflammatory factors present within the disc material.7
 The constellation of symptoms can include numbness and
weakness, but most often consists solely of leg pain that
radiates posterolaterally below the knee from nerves L5
and S1 (sciatica); or, less commonly, into the anterior thigh
or groin from nerves L2, L3, and L4 (femoralgia). 7

7
Schoenfeld,AJ, Weiner,BK. 2010. Treatment of lumbar disc herniation: Evidence-based practice.
International Journal of General Medicine :3 209–214.
 Sensory abnormalities in the genitals, anus, or perineum often
coupled with loss of bladder control (cauda equina syndrome),
as well as progressive loss of sensation or motor function in
the legs, are ominous signs and warrant urgent evaluation and
treatment.7

Schoenfeld,AJ, Weiner,BK. 2010. Treatment of lumbar disc herniation: Evidence-based practice. International
7

Journal of General Medicine :3 209–214.

8
Thomas, SA. 2003. Spinal Stenosis: History and Physical Examination. Phys Med Rehabil Clin N
AM ;14:29-39.
Thank You