LSS Clinical Presentation

• Clinical Presentation of LSS - History and MOI:

  • Age 55 and over
  • More common in males
  • Usually gradual insidious pain / history of OA / history of trauma
• Clinical Presentation of LSS - Subjective Features:

  • Lower back pain
  • Report bilateral neurological signs and symptoms
  • Must rule out other red flags and upper motor neurone involvement during assessment
  • Usually with bilaterally referred pain
  • Morning stiffness
  • Aggs: pain in standing, walking (only walk short distances)
  • Eases: lumbar flexion/sitting
• Clinical Presentation of LSS - Objective Features:

  • Bilateral symptoms
  • Gait disturbances / balance disturbances
  • Positive neuro integrity (lower motor neurone)
  • Weakness / progressive weakness
  • Numbness and/or pins and needs (can be progressive)
  • Reduced reflexes
  • Neurogenic Claudication
  • ? pts might be at risk of cauda equina syndrome
• Clinical Presentation of LSS - Key impairments:

  • Pain / weakness / decreased muscle power and consequently range of motion
  • depending on affected nerve root level(s)
• Clinical Presentation of LSS - Does this patient warrant a scan?

  • if patient doesnt have progressive signs and symptoms (progressive muscles weakness due to motor control problems or progressive anaesthesia or paraesthesia) and they've been stable, the patient wont need a scan
  • if we think pts have symptoms of cauda equina syndrome from asking special questions, they need instant referral to A&E