D. Spinal stenosis – Explanation
This is a classic presentation of spinal stenosis. Whilst peripheral arterial disease is an obvious
differential the characteristic relieving factors of the pain and normal vascular examination point
away from this diagnosis.
Lower back pain
Lower back pain (LBP) is one of the most common presentations seen in practice. Whilst the
majority of presentations will be of a non-specific muscular nature it is worth keeping in mind
possible causes which may need specific treatment.
Red flags for lower back pain
- age < 20 years or > 50 years
- history of previous malignancy
- night pain
- history of trauma
- systemically unwell e.g. weight loss, fever
The table below indicates some specific causes of LBP:
| Facet joint | May be acute or chronic Pain worse in the morning and on standing On examination there may be pain over the facets. The pain is typically worse on extension of the back |
| Spinal stenosis | Usually gradual onset Unilateral or bilateral leg pain (with or without back pain), numbness, and weakness which is worse on walking. Resolves when sits down. Pain may be described as ‘aching’, ‘crawling’. Relieved by sitting down, leaning forwards and crouching down Clinical examination is often normal Requires MRI to confirm diagnosis |
| Ankylosing spondylitis |
Typically a young man who presents with lower back pain and stiffness Stiffness is usually worse in morning and improves with activity Peripheral arthritis (25%, more common if female) |
| Peripheral arterial disease |
Pain on walking, relieved by rest Absent or weak foot pulses and other signs of limb ischemia Past history may include smoking and other vascular diseases |
