Lumbar Spinal Stenosis Cluster | Neurogenic Claudication | Low back pain

If lumbar spinal stenosis becomes symptomatic it will often lead to neurogenic claudication. This means that the spinal cord or a spinal root is becoming entrapped due to the narrowing of the spinal canal or the intervertebral foramen. This narrowing is usually degenerative and can come from, osteophyte formation, thickening of the ligamentum flavum, spondylarthrosis, or a disc protrusion.

The clinical prediction rule of cook from the year 2010 contains a cluster of 5 elements from patient-history taking and observation that are predictive of lumbar spinal stenosis.According to the author zero positive findings lead to a sensitivity of 96% and a negative likelihood ratio of 0.19 and 4 or more positive findings lead to a specificity of 98% and a positive likelihood for spinal lumbar stenosis of 4.6. In practice, the use of this clinical prediction rule is moderate.

The cluster of Cook contains the following elements:

1. Bilateral symptoms of neurological nature, so we are talking about possible pain, impaired sensitivity, loss of muscle strength etc. in both lower extremeties
2. Leg pain more than back pain, which is common if nerve roots are affected
3. Pain during walking or standing, which is due to the fact that the vertebral canal, as well as the intervertebral foramen narrow in these positions
4. Pain relief upon sitting and this has to do with the fact that we are creating more room again in vertebral canal and intervertebral foramen
5. Age > 48y and this is due to the fact that the incidence of spinal stenosis is rising with age and typically observed in people above 60.

Other common tests for lumbar spinal stenosis are:

• Modified Romberg Sign
• Two-Stage Treadmill Test
• Kemp’s Test

Cook, C., Brown, C., Michael, K., Isaacs, R., Howes, C., Richardson, W., … & Hegedus, E. (2011). The clinical value of a cluster of patient history and observational findings as a diagnostic support tool for lumbar spine stenosis. Physiotherapy Research International, 16(3), 170-178.