Spinal Stenosis

Herniated Disc




Laterality of symptoms



Straight leg raising



Sensory changes

Fleeting, changing


Motor changes

Absent to fleeting


Reflex change



and forces the patient to stop ambulating. Following a short period of rest, especially if the patient sits down or stoops forward, walking can be resumed. Some patients notice that they can ambulate farther when they walk uphill whereas downhill walking precipitates symptoms rather early. The pain may be sharp or may feel as if vices or bands have been applied to the legs. Frequently, the pain is concentrated around the calves. This may be accompanied by fleeting numbness and paraesthesia. These symptoms may appear unilaterally or bilaterally and are not stable in nature. The patient remains totally asymptomatic while sitting or lying down. Quite frequently the physical examination remains entirely normal. Not infrequently decreased reflexes or areflexia may be found, a common finding also in healthy elderly subjects. The straight leg raising test remains negative. Infrequently motor weakness may be found.

Neurogenic claudication and vascular claudication may be difficult to differentiate. At times, both conditions may occur simultaneously. Table 4-1 summarizes the similarities and differences between the two conditions. Differentiation between spinal stenosis and herniated disk is presented in Table 4-2.

Imaging Studies

In cervical and lumbar stenosis the X-rays may show multilevel disc degeneration accompanied by anterior and posterior osteophytes,

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