Spinal stenosis physical examination: Difference between revisions

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{{Spinal stenosis}}
{{Spinal stenosis}}


{{CMG}}; {{AE}} {{MMJ}}
,{{CMG}}; {{AE}}{{MMJ}}


==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Patients with spinal stenosis usually appear normal. Patients with spinal stenosis usually have a normal vital signs.Physical examination of patients with spinal stenosis may be remarkable for: Neck pain and tenderness, [[Lower back pain]] and tenderness, [[Scrotal]] and [[perianal]] [[claudication]], [[Hyperreflexia]], positive [[Romberg's test|Romberg test]], decrease in upper extremity [[sensation|sensation,]] weak knee and [[ankle]] reflexes, leg [[muscle]] weakness bilaterally, positive straight [[leg]] raise test, abnormal [[gait|gait,]] bilateral [[Calf muscle|calf muscle atrophy]], weak [[knee]] and [[Ankle reflex|ankle reflexes]] and muscle [[atrophy]].
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
Physical examination of patients with [disease name] is usually normal.


OR
Physical examination of patients with spinal stenosis may be remarkable for: Neck pain and tenderness, [[Lower back pain]] and tenderness, [[Scrotal]] and [[perianal]] [[claudication]], [[Hyperreflexia]], positive [[Romberg's test|Romberg test]], decrease in upper extremity [[sensation|sensation,]] weak knee and [[ankle]] reflexes, leg [[muscle]] weakness bilaterally, positive straight [[leg]] raise test, abnormal [[gait|gait,]] bilateral [[Calf muscle|calf muscle atrophy]], weak [[knee]] and [[Ankle reflex|ankle reflexes]] and muscle [[atrophy]].


Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Spinal stenosis is more likely when<ref name="pmid29031994">{{cite journal| author=Genevay S, Courvoisier DS, Konstantinou K, Kovacs FM, Marty M, Rainville J et al.| title=Clinical classification criteria for neurogenic claudication caused by lumbar spinal stenosis. The N-CLASS criteria. | journal=Spine J | year= 2018 | volume= 18 | issue= 6 | pages= 941-947 | pmid=29031994 | doi=10.1016/j.spinee.2017.10.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29031994  }} </ref>:


OR
* Age over 60 years
 
* Positive 30-second extension test
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
* Negative straight leg test
 
* Pain in both legs
OR
* Leg pain relieved by sitting
 
* Leg pain decreased by leaning forward or flexing the spine
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
===Appearance of the Patient===


===Appearance of the Patient===
*Patients with spinal stenosis usually appear normal.  
*Patients with [disease name] usually appear [general appearance].  


===Vital Signs===
===Vital Signs===
 
*Patients with spinal stenosis usually have a normal vital signs.
*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
* Skin examination of patients with spinal stenosis is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
*HEENT examination of patients with spinal stenosis is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
 
===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
*In patients with cervical spinal stenosis, neck physical examination may be positive for:
OR
**Neck pain and tenderness<ref name="pmid196261742">{{cite journal| author=Meyer F, Börm W, Thomé C| title=Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment. | journal=Dtsch Arztebl Int | year= 2008 | volume= 105 | issue= 20 | pages= 366-72 | pmid=19626174 | doi=10.3238/arztebl.2008.0366 | pmc=2696878 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19626174  }}</ref><ref name="pmid151950452">{{cite journal| author=Kukurin GW| title=The amelioration of symptoms in cervical spinal stenosis with spinal cord deformation through specific chiropractic manipulation: a case report with long-term follow-up. | journal=J Manipulative Physiol Ther | year= 2004 | volume= 27 | issue= 5 | pages= e7 | pmid=15195045 | doi=10.1016/j.jmpt.2004.04.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15195045  }}</ref>
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
 
===Lungs===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
*Pulmonary examination of patients with spinal stenosis is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
*Cardiovascular examination of patients with spinal stenosis is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
 
===Abdomen===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
*Abdominal examination of patients with spinal stenosis is usually normal.
OR
*[[Abdominal distention]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
 
===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
*Back examination of patients with spinal stenosis is usually positive for:
OR
**[[Lower back pain]] and tenderness<ref name="pmid194903712">{{cite journal| author=Kuramoto A, Chang L, Graham J, Holmes S| title=Lumbar spinal stenosis with exacerbation of back pain with extension: a potential contraindication for supine MRI with sedation. | journal=J Neuroimaging | year= 2011 | volume= 21 | issue= 1 | pages= 92-4 | pmid=19490371 | doi=10.1111/j.1552-6569.2009.00382.x | pmc=3157482 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19490371  }}</ref><ref name="pmid202276462">{{cite journal| author=Genevay S, Atlas SJ| title=Lumbar spinal stenosis. | journal=Best Pract Res Clin Rheumatol | year= 2010 | volume= 24 | issue= 2 | pages= 253-65 | pmid=20227646 | doi=10.1016/j.berh.2009.11.001 | pmc=2841052 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20227646  }}</ref>
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
*[[Genitourinary]] examination of patients with spinal stenosis is usually positive for:
OR
**[[Scrotal]] and [[perianal]] [[claudication]]<ref name="pmid257053422">{{cite journal| author=Oh JY, Tan JH, Teo TW, Hee HT| title=Spinal stenosis presenting with scrotal and perianal claudication. | journal=Asian Spine J | year= 2015 | volume= 9 | issue= 1 | pages= 103-5 | pmid=25705342 | doi=10.4184/asj.2015.9.1.103 | pmc=4330204 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25705342  }}</ref>
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
 
===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
*[[Neuromuscular]] examination of patients with spinal stenosis is usually positive for:
OR
**[[Hyperreflexia]]<ref name="pmid264305892">{{cite journal| author=Park MS, Moon SH, Kim TH, Oh JK, Lyu HD, Lee JH et al.| title=Asymptomatic Stenosis in the Cervical and Thoracic Spines of Patients with Symptomatic Lumbar Stenosis. | journal=Global Spine J | year= 2015 | volume= 5 | issue= 5 | pages= 366-71 | pmid=26430589 | doi=10.1055/s-0035-1549031 | pmc=4577327 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26430589  }}</ref><ref name="pmid243033442">{{cite journal| author=Akhavan-Sigari R, Rohde V, Alaid A| title=Cervical spinal canal stenosis and central disc herniation c3/4 in a man with primary complaint of thigh pain. | journal=J Neurol Surg Rep | year= 2013 | volume= 74 | issue= 2 | pages= 101-4 | pmid=24303344 | doi=10.1055/s-0033-1349202 | pmc=3836946 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24303344  }}</ref><ref name="pmid216071842">{{cite journal| author=Kim KT, Ahn SW, Kwon JT, Kim YB| title=Leg weakness in a patient with lumbar stenosis and adrenal insufficiency. | journal=J Korean Neurosurg Soc | year= 2011 | volume= 49 | issue= 4 | pages= 234-6 | pmid=21607184 | doi=10.3340/jkns.2011.49.4.234 | pmc=3098429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21607184  }}</ref>
*Patient is usually oriented to persons, place, and time
**positive Romberg test
* Altered mental status
**Decrease in upper extremity [[sensation]]<ref name="pmid243033442">{{cite journal| author=Akhavan-Sigari R, Rohde V, Alaid A| title=Cervical spinal canal stenosis and central disc herniation c3/4 in a man with primary complaint of thigh pain. | journal=J Neurol Surg Rep | year= 2013 | volume= 74 | issue= 2 | pages= 101-4 | pmid=24303344 | doi=10.1055/s-0033-1349202 | pmc=3836946 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24303344  }} </ref><ref name="pmid216071842">{{cite journal| author=Kim KT, Ahn SW, Kwon JT, Kim YB| title=Leg weakness in a patient with lumbar stenosis and adrenal insufficiency. | journal=J Korean Neurosurg Soc | year= 2011 | volume= 49 | issue= 4 | pages= 234-6 | pmid=21607184 | doi=10.3340/jkns.2011.49.4.234 | pmc=3098429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21607184  }} </ref>
* Glasgow coma scale is ___ / 15
**Weak knee and [[ankle]] reflexes<ref name="pmid216071842">{{cite journal| author=Kim KT, Ahn SW, Kwon JT, Kim YB| title=Leg weakness in a patient with lumbar stenosis and adrenal insufficiency. | journal=J Korean Neurosurg Soc | year= 2011 | volume= 49 | issue= 4 | pages= 234-6 | pmid=21607184 | doi=10.3340/jkns.2011.49.4.234 | pmc=3098429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21607184  }} </ref>
* Clonus may be present
**Leg [[muscle]] weakness bilaterally<ref name="pmid216071842">{{cite journal| author=Kim KT, Ahn SW, Kwon JT, Kim YB| title=Leg weakness in a patient with lumbar stenosis and adrenal insufficiency. | journal=J Korean Neurosurg Soc | year= 2011 | volume= 49 | issue= 4 | pages= 234-6 | pmid=21607184 | doi=10.3340/jkns.2011.49.4.234 | pmc=3098429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21607184  }} </ref>
* Hyperreflexia / hyporeflexia / areflexia
**Positive straight [[leg]] raise test<ref name="pmid259837672">{{cite journal| author=Tabesh H, Tabesh A, Fakharian E, Fazel M, Abrishamkar S| title=The effect of age on result of straight leg raising test in patients suffering lumbar disc herniation and sciatica. | journal=J Res Med Sci | year= 2015 | volume= 20 | issue= 2 | pages= 150-3 | pmid=25983767 | doi= | pmc=4400709 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25983767  }}</ref>
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
**Abnormal [[gait]]<ref name="pmid204049542">{{cite journal| author=Kim YS, Park SJ, Oh IS, Kwan JY| title=The clinical effect of gait load test in two level lumbar spinal stenosis. | journal=Asian Spine J | year= 2009 | volume= 3 | issue= 2 | pages= 96-100 | pmid=20404954 | doi=10.4184/asj.2009.3.2.96 | pmc=2852081 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20404954  }}</ref>
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)
 
===Extremities===
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
*Extremities examination of patients with spinal stenosis is usually positive for:
OR
**Bilateral [[Calf muscle|calf muscle atrophy]]<ref name="pmid21607184">{{cite journal| author=Kim KT, Ahn SW, Kwon JT, Kim YB| title=Leg weakness in a patient with lumbar stenosis and adrenal insufficiency. | journal=J Korean Neurosurg Soc | year= 2011 | volume= 49 | issue= 4 | pages= 234-6 | pmid=21607184 | doi=10.3340/jkns.2011.49.4.234 | pmc=3098429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21607184  }} </ref>
*[[Clubbing]]  
**Weak [[knee]] and [[Ankle reflex|ankle reflexes]]<ref name="pmid21607184">{{cite journal| author=Kim KT, Ahn SW, Kwon JT, Kim YB| title=Leg weakness in a patient with lumbar stenosis and adrenal insufficiency. | journal=J Korean Neurosurg Soc | year= 2011 | volume= 49 | issue= 4 | pages= 234-6 | pmid=21607184 | doi=10.3340/jkns.2011.49.4.234 | pmc=3098429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21607184  }} </ref>
*[[Cyanosis]]  
*Muscle [[atrophy]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}{{WH}} {{WS}}
 
{{WH}}
{{WS}}
[[Category: (name of the system)]]
[[Category: (name of the system)]]

Latest revision as of 04:16, 15 February 2019

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,Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Patients with spinal stenosis usually appear normal. Patients with spinal stenosis usually have a normal vital signs.Physical examination of patients with spinal stenosis may be remarkable for: Neck pain and tenderness, Lower back pain and tenderness, Scrotal and perianal claudication, Hyperreflexia, positive Romberg test, decrease in upper extremity sensation, weak knee and ankle reflexes, leg muscle weakness bilaterally, positive straight leg raise test, abnormal gait, bilateral calf muscle atrophy, weak knee and ankle reflexes and muscle atrophy.

Physical Examination

Physical examination of patients with spinal stenosis may be remarkable for: Neck pain and tenderness, Lower back pain and tenderness, Scrotal and perianal claudication, Hyperreflexia, positive Romberg test, decrease in upper extremity sensation, weak knee and ankle reflexes, leg muscle weakness bilaterally, positive straight leg raise test, abnormal gait, bilateral calf muscle atrophy, weak knee and ankle reflexes and muscle atrophy.

Spinal stenosis is more likely when[1]:

  • Age over 60 years
  • Positive 30-second extension test
  • Negative straight leg test
  • Pain in both legs
  • Leg pain relieved by sitting
  • Leg pain decreased by leaning forward or flexing the spine

Appearance of the Patient

  • Patients with spinal stenosis usually appear normal.

Vital Signs

  • Patients with spinal stenosis usually have a normal vital signs.

Skin

  • Skin examination of patients with spinal stenosis is usually normal.

HEENT

  • HEENT examination of patients with spinal stenosis is usually normal.

Neck

  • In patients with cervical spinal stenosis, neck physical examination may be positive for:
    • Neck pain and tenderness[2][3]

Lungs

  • Pulmonary examination of patients with spinal stenosis is usually normal.

Heart

  • Cardiovascular examination of patients with spinal stenosis is usually normal.

Abdomen

  • Abdominal examination of patients with spinal stenosis is usually normal.

Back

  • Back examination of patients with spinal stenosis is usually positive for:

Genitourinary

Neuromuscular

Extremities

References

  1. ↑ Genevay S, Courvoisier DS, Konstantinou K, Kovacs FM, Marty M, Rainville J; et al. (2018). "Clinical classification criteria for neurogenic claudication caused by lumbar spinal stenosis. The N-CLASS criteria". Spine J. 18 (6): 941–947. doi:10.1016/j.spinee.2017.10.003. PMID 29031994.
  2. ↑ Meyer F, Börm W, Thomé C (2008). "Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment". Dtsch Arztebl Int. 105 (20): 366–72. doi:10.3238/arztebl.2008.0366. PMC 2696878. PMID 19626174.
  3. ↑ Kukurin GW (2004). "The amelioration of symptoms in cervical spinal stenosis with spinal cord deformation through specific chiropractic manipulation: a case report with long-term follow-up". J Manipulative Physiol Ther. 27 (5): e7. doi:10.1016/j.jmpt.2004.04.009. PMID 15195045.
  4. ↑ Kuramoto A, Chang L, Graham J, Holmes S (2011). "Lumbar spinal stenosis with exacerbation of back pain with extension: a potential contraindication for supine MRI with sedation". J Neuroimaging. 21 (1): 92–4. doi:10.1111/j.1552-6569.2009.00382.x. PMC 3157482. PMID 19490371.
  5. ↑ Genevay S, Atlas SJ (2010). "Lumbar spinal stenosis". Best Pract Res Clin Rheumatol. 24 (2): 253–65. doi:10.1016/j.berh.2009.11.001. PMC 2841052. PMID 20227646.
  6. ↑ Oh JY, Tan JH, Teo TW, Hee HT (2015). "Spinal stenosis presenting with scrotal and perianal claudication". Asian Spine J. 9 (1): 103–5. doi:10.4184/asj.2015.9.1.103. PMC 4330204. PMID 25705342.
  7. ↑ Park MS, Moon SH, Kim TH, Oh JK, Lyu HD, Lee JH; et al. (2015). "Asymptomatic Stenosis in the Cervical and Thoracic Spines of Patients with Symptomatic Lumbar Stenosis". Global Spine J. 5 (5): 366–71. doi:10.1055/s-0035-1549031. PMC 4577327. PMID 26430589.
  8. ↑ 8.0 8.1 Akhavan-Sigari R, Rohde V, Alaid A (2013). "Cervical spinal canal stenosis and central disc herniation c3/4 in a man with primary complaint of thigh pain". J Neurol Surg Rep. 74 (2): 101–4. doi:10.1055/s-0033-1349202. PMC 3836946. PMID 24303344.
  9. ↑ 9.0 9.1 9.2 9.3 Kim KT, Ahn SW, Kwon JT, Kim YB (2011). "Leg weakness in a patient with lumbar stenosis and adrenal insufficiency". J Korean Neurosurg Soc. 49 (4): 234–6. doi:10.3340/jkns.2011.49.4.234. PMC 3098429. PMID 21607184.
  10. ↑ Tabesh H, Tabesh A, Fakharian E, Fazel M, Abrishamkar S (2015). "The effect of age on result of straight leg raising test in patients suffering lumbar disc herniation and sciatica". J Res Med Sci. 20 (2): 150–3. PMC 4400709. PMID 25983767.
  11. ↑ Kim YS, Park SJ, Oh IS, Kwan JY (2009). "The clinical effect of gait load test in two level lumbar spinal stenosis". Asian Spine J. 3 (2): 96–100. doi:10.4184/asj.2009.3.2.96. PMC 2852081. PMID 20404954.
  12. ↑ 12.0 12.1 Kim KT, Ahn SW, Kwon JT, Kim YB (2011). "Leg weakness in a patient with lumbar stenosis and adrenal insufficiency". J Korean Neurosurg Soc. 49 (4): 234–6. doi:10.3340/jkns.2011.49.4.234. PMC 3098429. PMID 21607184.

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