Figure 1. Anteroposterior radiograph of the lumbar spine.
Figure 2. Lateral radiograph of the lumbar spine.
A 71-year-old man presents with chronic lower back pain for many years. He feels as though his legs are getting weaker, and he is experiencing difficulty walking long distances. Anteroposterior and lateral radiographs of the lumbar spine are obtained (Figures 1 and 2).
Which finding is most likely to be present in this patient?
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Spinal stenosis is a narrowing of the spinal canal and neural foramina that results in nerve root compression.1 This condition occurs most often in individuals >60 years of age.2 Compression of the nerve roots can cause varying degrees of lower back and leg pain. Unlike symptoms of lumbar herniated disc, symptoms of lumbar stenosis rarely follow a dermatomal distribution. Pain associated with lumbar stenosis usually radiates to both thighs when walking. Prolonged standing or walking increases pain down the buttocks and thighs. Patients with symptomatic lumbar stenosis have a distinct hunched-over, wide-based gait and stance. Lumbar stenosis causes compression of the proprioceptive fibers in the spine resulting in poor balance with walking.
The Romberg test is often positive in patients with lumbar stenosis.3 The Romberg test involves having the patient stand in one spot, with feet together and arms out to the side. The patient is asked to maintain balance with his or her eyes open and then with the eyes closed. The Romberg test is scored by counting the number of seconds a patient can stay balanced with his or her eyes closed; a positive Romberg test is determined when patients are unable to maintain balance with their eyes closed.
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
- Moore D. Lumbar spinal stenosis. OrthoBullets website. https://www.orthobullets.com/spine/2037/lumbar-spinal-stenosis. Updated April 15, 2018. Accessed February 11, 2019.
- Lumbar spinal stenosis. OrthoInfo website. https://orthoinfo.aaos.org/en/diseases–conditions/lumbar-spinal-stenosis. Accessed February 12, 2019.
- Katz JN, Dalgas M, Stucki G, et al. Degenerative lumbar spinal stenosis. Diagnostic value of the history and physical examination. Arthritis Rheum. 1995;38(9):1236-1241.