MULTILEVEL LUMBAR SPONDYLOSIS WITH SPINAL STENOSIS
‘Ammar Muttaqin A., Normaizatul Afizah I. & Nurul Qomariah A. S.
abstract
Narrowing of the spinal canal or foramina is a common finding in spine imaging of the elderly. We present a case of multilevel lumbar spondylosis with spinal stenosis. Mr X, 79-year-old male with underlying Diabetes Mellitus, hypertension and minor coronary artery disease presented to the hospital with low back pain radiating to lower limb for 4 years, progressively worsening, affecting the ability to walk steadily for prolonged period, and the worst pain score is 9/10, and the least pain score is 4/10. It was associated with intermittent neuropathic symptoms like numbness from waist downwards, nocturnal claudication, and weakness. Otherwise, he had no fever, no vomiting, no headache, no chest and abdominal pain, no respiratory distress, palpitations, and no urinary incontinence. Management includes continue insulin as patient has diabetes mellitus, nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, anti-seizure drugs, opioids, and start physical therapy. Most patients have a progressive presentation and are offered non-operative management as first treatment strategy.
references
1. Melancia JL, Francisco AF, Antunes JL. Spinal stenosis. Handb Clin Neurol [Internet]. 2014 [cited 2023 Dec 27];119:541–9. Available from: https://pubmed.ncbi.nlm.nih.gov/24365318/
2. Jezek J, Sepitka J, Daniel M, Kujal P, Blankova A, Waldauf P, et al. The role of vascularization on changes in ligamentum flavum mechanical properties and development of hypertrophy in patients with lumbar spinal stenosis. Spine J. 2020 Jul 1;20(7):1125–33.
3. 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. PMID: 9575322.
4. Schönström N, Willén J. Imaging lumbar spinal stenosis. Radiol Clin North Am [Internet]. 2001 Jan 1 [cited 2023 Dec 27];39(1):31–53. Available from: https://pubmed.ncbi.nlm.nih.gov/11221505/
5. Binder DK, Schmidt MH, Weinstein PR. Lumbar spinal stenosis. Semin Neurol. 2002 Jun;22(2):157–65.
6. Kreiner DS, Shaffer WO, Baisden JL, Gilbert TJ, Summers JT, Toton JF, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J [Internet]. 2013 [cited 2023 Dec 27];13(7):734–43. Available from: https://pubmed.ncbi.nlm.nih.gov/23830297/
2. Jezek J, Sepitka J, Daniel M, Kujal P, Blankova A, Waldauf P, et al. The role of vascularization on changes in ligamentum flavum mechanical properties and development of hypertrophy in patients with lumbar spinal stenosis. Spine J. 2020 Jul 1;20(7):1125–33.
3. 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. PMID: 9575322.
4. Schönström N, Willén J. Imaging lumbar spinal stenosis. Radiol Clin North Am [Internet]. 2001 Jan 1 [cited 2023 Dec 27];39(1):31–53. Available from: https://pubmed.ncbi.nlm.nih.gov/11221505/
5. Binder DK, Schmidt MH, Weinstein PR. Lumbar spinal stenosis. Semin Neurol. 2002 Jun;22(2):157–65.
6. Kreiner DS, Shaffer WO, Baisden JL, Gilbert TJ, Summers JT, Toton JF, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J [Internet]. 2013 [cited 2023 Dec 27];13(7):734–43. Available from: https://pubmed.ncbi.nlm.nih.gov/23830297/