Imaging Spinal Stenosis

Kiran S. Talekar, MD; Mougnyan Cox, MD; Elana Smith, MD; Adam E. Flanders, MD


Appl Radiol. 2017;46(1) 

In This Article

Indications for Imaging Stenosis

Typical clinical features of stenosis include buttock or lower extremity pain with a positive straight leg raise test, radiculopathy or neurogenic claudication. Neurogenic claudication has been variably defined by radiculopathy or pain in the lower extremity that worsens with walking and improves with sitting or bending forward.[1,10] The presence of these clinical findings suggests disc herniation and/or stenosis. Uncomplicated acute low back pain or radiculopathy is a benign, self-limited condition that does not warrant any imaging studies. Imaging is considered in those patients who have had 4 to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. Imaging may be considered earlier if there is a history of malignancy, concern for infection, a fracture, symptoms of true myelopathy (progressive or severe neurologic deficits), in the setting of cauda equina syndrome (urinary retention, fecal incontinence, motor deficit at multiple levels, and saddle anesthesia), or with history of back surgery.[11–13] Degenerative changes are more common with increasing age. As these findings may be seen in both symptomatic and asymptomatic individuals, it is important that imaging findings be correlated with the physical exam.