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Examination Findings and Self-Reported Walking Capacity in Patients With Lumbar Spinal Stenosis

MD Iversen, PT, SD, is Associate Professor, Department of Physical Therapy, Graduate School for Health Sciences, Simmons College, Boston, Mass, and Instructor in Medicine, RBB Multipurpose Arthritis and Musculoskeletal Diseases Center, Department of Medicine, Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
JN Katz, MD, is Associate Professor, RBB Multipurpose Arthritis and Musculoskeletal Diseases Center, Department of Medicine, Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School

Address all correspondence to Dr Iversen at Department of Physical Therapy, Graduate School for Health Sciences, Simmons College, 300 The Fenway, Boston, MA 02115 (USA) (iversen{at}simmons.edu)

Background and Purpose. Spinal stenosis is a common, often disabling, condition resulting from compression of the cauda equina and nerve roots. This study was designed to: (1) characterize the impairments of patients with lumbar spinal stenosis (LSS) and (2) to identify predictors of self-reported walking capacity. Subjects. Forty-three patients with symptomatic LSS, from 3 specialty clinics, were evaluated. Twenty-eight subjects (65%) were female. The subjects' median age was 73.6 years (=72.4, SD=10.3, range=45.–90.7), and the median duration of low back pain was 24 months (=36.6, SD=41.6, range=0–216). Methods. Demographic data, medical history, and information about low back pain and symptoms (eg, numbness, tingling, and lower-extremity weakness) were collected using a standardized questionnaire and physical examination. Results. Twenty-two subjects (51%) had lower-extremity weakness, primarily of the extensor hallucis longus muscle. Thirty-five subjects (81%) had absent or decreased neurosensory responses (eg, pinprick, vibration, reflexes), and 28 subjects (66%) reported that they were unable to walk farther than 2 blocks. Women were more likely than men to report difficulties walking, as were subjects with abnormal Romberg test scores and those with greater pain during walking. Discussion and Conclusion. Pain and balance problems appeared to be the primary factors limiting ambulation in our subjects with LSS.

Key Words: Clinical signs and symptoms • Lumbar spinal stenosis

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