Spine

Lumbar spinal stenosis

Mechanism

Narrowing of the vertebral canal by three processes at once: hypertrophy of the ligamenta flava, facet joint osteoarthritis and disc bulging. All three increase with age.

Recognition

Neurogenic claudication: pain and heaviness in the legs on standing and walking, easing on bending forward or sitting. Cycling is often far better tolerated than walking, precisely because the trunk is flexed.

Course

The distinction from vascular claudication lies in posture dependence: with a vascular cause standing still helps, with a neurogenic cause only bending forward helps.

What the guideline recommends

The KNGF guideline places this picture among the specific causes of low back pain and asks you to keep following the red flags. Flexion-based exercise therapy and building walking distance match the mechanism.

Structures

• Ligamenta flava (Yellow ligaments)
• Multifidus, lumbar part

Joints involved

• Facet joints (artt. zygapophysiales)
• Intervertebral disc (symphysis intervertebralis)

Clinical tests

• Posteroanterior pressure

Sources

• Swart NM, Apeldoorn AT, Conijn D, Meerhoff GA, Ostelo RWJG (red.). KNGF-richtlijn Lage rugpijn en lumbosacraal radiculair syndroom. Koninklijk Nederlands Genootschap voor Fysiotherapie / VvOCM. Amersfoort. 2021 https://www.kngf.nl/kennisplatform