1110:
1699:
spinal nerve roots. Advances in this procedure involve finding ways to access the spinal cord with minimal incisions and to more effectively create hinges that replicate normal functioning of the spine. In addition to
Laminoplasty, spinal fusion surgeries have also been of growing interest to orthopedic surgeons and neurosurgeons. This process involves connecting two vertebrae of the bones together to reduce pain or correct any spinal deformities. As such this form of surgery has the potential to treat the underlying cause of
1182:. In conjunction with these stretches, various strengthening exercises are often implemented, targeting the core, lower back and hip muscles. Common exercises include bridges, bird to dog, tabletop leg press, clamshell and knees to chest. Depending on the age, mobility and physical health of patients, a combination of easier and more difficult exercises should be prescribed to suit the patient's needs. More difficult exercises may include the incorporation of
414:, or weakness in the lower back, calves, glutes, and/or thighs and is precipitated by walking and prolonged standing. However, the symptoms vary depending on the severity and cause of the condition. Lighter symptoms include pain or heaviness in the legs, hips, glutes and lower back, post-exercise. Mild to severe symptoms include prolonged constant pain, tiredness and discomfort in the lower half of the body. In severe cases, impaired
999:
40:
592:, the spinal canal in the lumbar spine narrows, causing damage and arthritic changes in the spine. These changes, such as bulging disks, thickening of ligaments and overgrowth of bone spurs, lead to pressure and potentially damage to the spinal nerve roots. The compression of the spinal nerve roots that control movements and sensations in the lower body subsequently causes the symptoms of
1694:, current methods involve partial or complete removal of the lamina and segments of the spinal cord, leading to poor stability. Hence, orthopedic surgeons and neurosurgeons have been developing and researching other surgical techniques that reduce this side effect. Haruo Tsuji, in 1990, introduced a procedure known as
1682:(NGF) in the body. By blocking NGF in the body, Tanezumab aims to prevent pain signals produced in the body from reaching the brain, thus, reducing pain and providing relief for patients. Whilst positive results have been shown in several studies, further research is still necessary for its safe and effective use.
1703:. However, these types of surgeries are difficult and dangerous to perform due to the sensitive nature of the spinal area. Additionally, these techniques are relatively new and thus, more research and advances in its methodology is still required for it to be considered a reliable and viable option to treat
1371:, are the most common reason patients 65 and older undergo spinal surgery. Surgery is generally reserved for patients whose symptoms do not improve with nonsurgical treatments, and the main objective of surgery is to relieve pressure on the spinal nerve roots and recover normal mobility and quality of life.
1698:
as an alternative to laminectomy and since then, variations and further developments have been made on that procedure, with developments still being currently. This procedure involves a reconstruction of the vertebral lamina such that it creates a hinge on one side, allowing for decreased pressure on
1318:
that induce a sensation of pain and discomfort. However, the exact mechanism of
Gabapentin’s functioning in the body is not completely understood and current knowledge is based on experimental studies that target the nervous system. Methylcobalamin is another medication that targets the nervous
1279:
Abdominal draw-in (knee to chest) - Lying flat on the back, bend both legs and bring knees towards the chest without lifting the back from the ground and then straighten legs again. For a more difficult version of the exercise, keep one leg bent and feet on the ground and bring the other leg towards
525:
constant discomfort, pain or numbness is experienced. This results in patients to have decreased mobility and function as excessive or constant movements cause pain. Exercise and prolonged walking often become difficult and are triggers of pain, tiredness, numbness and heaviness in the legs, lower
501:
is classically distinguished by symptoms improving or worsening with certain activities and manoeuvres. Pain may occur with walking, standing, and/or back extension. Sitting and bending or leaning forward tend to provide relief. Patients may also report that pain is worse while walking down stairs
718:
increases with each additional suggestive clinical finding. Therefore, a combination of signs and symptoms may be more helpful in diagnosing NC than any single feature of the history or physical exam. These signs and symptoms include pain triggered by standing, pain relieved by sitting, symptoms
1665:
patients are generally steroids, pain relievers or anti-inflammatories that aim to reduce pain and provide pain-relief. However, studies have found that these medications only provide temporary relief for patients, and do not provide a permanent solution, with symptoms often reoccurring several
1414:
alternative to spinal decompression has also been heavily debated, with studies showing conflicting results. While studies show that surgery improves walking ability, minimizes constant pain and improves quality of life, comparisons between the efficacy of surgical and nonsurgical treatment of
1133:
that affect a patient's quality of life. Therefore, the target of most treatments is to solve these complications. Currently, several treatment options are available to patients, and they can be grouped broadly into nonsurgical and surgical options. Nonsurgical treatments include medications,
1413:
The use of interspinous spacers is associated with increased costs and rates of reoperation, while evidence comparing effectiveness of the MILD procedure to spinal decompression is insufficient. The effectiveness of laminectomy, microdiscectomy, laminoplasty and spinal fusion surgeries as an
1243:
stretch - To stretch the right hip-flexor, bring the left leg forward, and kneel on the right knee. Push the pelvis forward (lean forward), whilst keeping the upper body straight. Hold the position for 30–45 seconds and relax. To stretch the left hip-flexor, bring swap the positions of the
1383:
in the spinal canal, and then the decompression of the spinal nerve root. Another surgical method of decompression is the
Fenestration method, which involves creating a small window in the spinal canal and then decompressing the nerves. Alternative surgical options include the use of
1620:
are not diverse and lack extensive and detailed research to support their effectiveness, resulting in patients having to choose from a small pool of treatment options, some of which may not be effective. This lack of evidence to support the effectiveness of treatment options for
1404:
in one or more segments of the spinal cord are usually sacrificed as well. Microdiscectomy is another surgical alternative which uses small incisions, and a miniature camera for viewing, to enter the spinal cord and release pressure on the nerve roots. Laminoplasty and
1150:. However, the quality of evidence supporting their use is not high enough for specific recommendations. Physical therapy is commonly prescribed to patients, but the quality of evidence supporting its use for neurogenic claudication is also low. One quarter of all
1198:
that contribute to the symptoms, and to strengthen those muscles to prevent further reocurrences of the condition. However, studies have found conflicting conclusions in regards to the effectiveness of physical therapy as a treatment option for
346:
is a medical condition most commonly caused by damage and compression to the lower spinal nerve roots. It is a neurological and orthopedic condition that affects the motor nervous system of the body, specifically, the lower back, legs, hips and
3403:
Ammendolia C, Côté P, Southerst D, Schneider M, Budgell B, Bombardier C, et al. (December 2018). "Comprehensive
Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial".
1269:
Quadruped opposite arm/leg (bird to dog) - On all fours (knees on ground and arms against floor supporting upper body) straighten one knee whilst straightening the opposite side arm and hold for 3 seconds and repeat for the other arm/leg
775:
do not correlate well with symptom severity. Therefore, imaging findings must be considered in the context of a patient's history and physical exam when seeking a diagnosis. The evidence for using objective imaging findings to define
465:
are prescribed in conjunction with physical therapy. Surgical treatments are predominantly used to relieve pressure on the spinal nerve roots and are used when nonsurgical interventions are ineffective or show no effective progress.
1512:
condition and thus, does not pose any community risks in terms of infectiousness. Rather, NC is associated with increasing age and mostly affects individuals over the age of 60. Age is a major contributing factor to the onset of
2686:
Ammendolia C, Stuber K, Tomkins-Lane C, Schneider M, Rampersaud YR, Furlan AD, Kennedy CA (June 2014). "What interventions improve walking ability in neurogenic claudication with lumbar spinal stenosis? A systematic review".
1247:
Lower trunk rotation - Lying down on the back, bring both knees towards your chest whilst keeping the back flat on the floor. Rotate the bent legs from the left to right side and vice versa whilst keeping back flat on the
1048:
patients often experience. However, because the severity of symptoms does not correlate well with the degree of stenosis and nerve root compression, a clear understanding of the specific pathogenesis remains challenging.
1289:
Medications such as NSAIDs, prostaglandin-based drugs, gabapentin, methylcobalamin and epidural steroid injections are often used in conjunction with physical therapy to treat patients with mild or moderate symptoms of
1409:
are other alternative surgical procedures that can be performed. However, they are relatively new methods which still require more research and advancements in order for it to be safely performed with minimal risks.
1265:
Posterior pelvic tilt (bridges) - Lying on the back, bend both legs and place your feet on the floor. Raise stomach from the ground, lifting the back and pelvis, until the back is straight. Hold for 5–10 seconds and
530:
may experience difficulties sleeping as lying down on their back causes discomfort and pain. In very extreme cases, bowel or bladder dysfunction can occur. However, this is a consequence of the underlying cause of
1666:
months following the disuse of medications. Hence, doctors have reported that it is important to research possible medications that can provide long term relief or a permanent solution for patients. Currently,
656:. These conditions contribute to the potential narrowing of the spinal cord, increasing pressure and inducing damage on the spinal nerve roots, thus, causing paing, tingling or weakness in the lower body.
2735:
Ammendolia C, Stuber K, de Bruin LK, Furlan AD, Kennedy CA, Rampersaud YR, et al. (May 2012). "Nonoperative treatment of lumbar spinal stenosis with neurogenic claudication: a systematic review".
1649:
find less long-term success in treating the condition through physical therapy. Thus, doctors have concluded that further research into the effectiveness of physical therapy as a treatment option for
1276:
Clamshell - Whilst lying on the side with knees bent inwards, bring the top knee up (whilst keeping leg bent) and hold for 3 seconds. To exercise the opposite leg, lie on the opposite side and repeat.
1194:
have also been found to strengthen and improve overall stability and strength in the core, lower back and hips. Ultimately, the aim of physical therapy is to loosen and relax the tight muscles and
1592:
is present in greater than 90% of patients and present in almost half of patients that present with low back pain, with over 200,000 people being affected in the United States. The prevalence of
1335:. They inhibit the inflammatory cascade signalling to reduce inflammation at sites of spinal nerve damage or pressure. Consequently, they reduce pain and provide relief to individuals with
1273:
Tabletop leg press press - Lying on the back, bring both knees towards the chest and then straighten both legs (such that legs are hanging in the air), whilst keeping the back flat on the ground.
497:
that extend into the lower extremities. These symptoms may involve only one leg, but they usually involve both. Leg pain is usually more significant than back pain in individuals who have both.
539:
involve increased pressure or damage to the nerves in the lower spine, damage and pressure on the nerves that extend to the bowel or bladder may occur, leading to bowel or bladder dysfunction.
355:
does not occur by itself, but rather, is associated with other underlying spinal or neurological conditions such as spinal stenosis or abnormalities and degenerative changes in the spine. The
3354:"Assessment and management of neurogenic claudication associated with lumbar spinal stenosis in a UK primary care musculoskeletal service: a survey of current practice among physiotherapists"
457:. Patients with minor symptoms are usually advised to undergo physical therapy, such as stretching and strengthening exercises. In patients with more severe symptoms, medications such as
526:
back and hips. Common tasks such as standing upright for an extended duration or picking up heavy objects may become increasingly difficult to perform. In addition, patients with severe
3524:"Evaluating the outcome of classic laminectomy surgery alone versus laminectomy with fixation surgery in patients with lumbar canal stenosis regarding improvement of pain and function"
695:
1596:
and spinal stenosis in elderly men is also evident, with studies finding that roughly 1 in 10 elderly men experience leg pain in combination with low back pain (symptoms of
982:
Both neurogenic claudication and vascular claudication manifest as leg pain with walking, but several key features help distinguish between these conditions. In contrast to
441:
depends on the severity and cause of the condition, and may be nonsurgical or surgical. Nonsurgical interventions include drugs, physical therapy, and spinal injections.
1653:
is necessary. With more detailed research, doctors will then be able to suggest the best treatment options for their patients, to help them recover from the condition.
1343:
patients that experience frequent or constant pain, their effectiveness has yielded mixed results in studies. Further research into their viability as a medication for
1129:
is the primary disabling feature of LSS. Constant discomfort and pain in the lower extremities and an inability to sleep and lying down are also disabling features of
562:. For example, a positive "stoop test" is observed if bending forward or stooping while walking relieves symptoms. Occasionally, patients may have other signs such as
986:, vascular claudication does not vary with changes in posture. Patients with vascular claudication may experience relief with standing, which may provoke symptoms in
1537:. Increased exercise activity in the form of strength training has also been found to increase bone density, muscle strength and thus, decrease the likelihood of
1637:
Studies have found that physical therapies such as stretches and strengthening exercises have yielded mixed results in terms of its effectiveness in treating
1087:, and nerve root compression is present one-third of the time. These dynamic changes in the shape of the spinal canal are more pronounced in individuals with
4091:
1174:
Patients that experience light to mild symptoms are commonly treated through physical therapy, which involves stretching and strengthening the lower back,
1226:
Posterior pelvic tilt (bridges) - Lying on the back, bend both legs and place your feet on the floor. Raise stomach from the ground, lifting the back and
1083:
narrow the spinal canal and compress the neurovasculature. Compared to a neutral position, extended spines exhibit 15% less cross-sectional area of the
1489:
condition over time, without the help of medical treatment or interventions, this is only prevalent in individuals with light or very mild symptoms of
1442:
often seek medical help and treatment due to the condition causing pain and affecting their quality of life. Consequently, the prognosis of untreated
502:
and improved while walking up stairs or using a bicycle or shopping cart. A positive "shopping cart sign" refers to the worsening of pain with spinal
1629:, current research into improving methods of surgery to minimize post-surgery complication and to improve quality of life have also been of concern.
1021:, the normal movements of the spine are interrupted. This results in spinal instability and more degenerative changes in spinal structures including
788:
Neurogenic claudication must be differentiated from other causes of leg pain, which may be present in a number of conditions involving the spine and
612:
may also be acquired from changes due to spinal surgery such as excess scar tissue or bone formation. Other secondary causes include space-occupying
1645:
in patients with light to mild symptoms, whilst others have shown the contrary. It has also been found that patients with more severe symptoms of
1310:, a key contributor of inflammation. By reducing inflammation, less pressure is put on the nerve roots, decreasing pain, and providing relief for
4540:
2294:
Messiah S, Tharian AR, Candido KD, Knezevic NN (March 2019). "Neurogenic
Claudication: a Review of Current Understanding and Treatment Options".
356:
1044:. The compression of these spinal nerve roots that control sensation and movement in the lower body results in the tingling, pain and weakness
1203:
patients. Thus, the low quality of evidence supporting its use has prompted further research into physical therapy as a treatment option for
1960:"Current Evidence for Diagnosis of Common Conditions Causing Low Back Pain: Systematic Review and Standardized Terminology Recommendations"
1454:, it is projected that the symptoms of NC can worsen over time, with roughly one-third of patients showing signs of improvement with time.
1056:
as a response to the compression of spinal nerves. The two main proposed mechanisms agree that neurovascular compression plays a role. The
2865:"Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial"
445:
is the main surgical intervention and is the most common back surgery in patients over 65. Other forms of surgical procedures include:
2487:"Bowel/bladder dysfunction and numbness in the sole of the both feet in lumbar spinal stenosis - A multicenter cross-sectional study"
95:
Persistent pain in the lower body, difficulties standing, walking, exercising or performing general tasks, discomfort during sleep,
4156:
Tsuji H, Itoh T, Sekido H, Yamada H, Katoh Y, Makiyama N, Yamagami T (1990). "Expansive laminoplasty for lumbar spinal stenosis".
469:
Diagnosis of neurogenic claudication is based on typical clinical features, the physical exam, and findings of spinal stenosis on
771:, but MRI is preferred. Abnormal MRI findings may be present in two-thirds of asymptomatic individuals, and imaging findings of
710:
diagnostic criteria currently exist, but evaluation and diagnosis is generally based on the patient history, physical exam, and
1237:
until a stretch is felt in the legs. Ensure your legs are straight. Once the stretch is felt, hold for 30–45 seconds and relax.
1625:
is especially prevalent in nonsurgical treatments, such as physical therapy and medications. Among surgical interventions for
990:. The walking distance necessary to produce pain in vascular claudication is more consistent than in neurogenic claudication.
2630:"Iatrogenic spondylolisthesis following laminectomy for degenerative lumbar stenosis: systematic review and current concepts"
2191:
1135:
1076:
904:
507:
1517:
due to spinal degenerative changes that are brought by aging and the weakening of bones and ligaments in the lumbar area.
1223:
Knee to chest stretch - Lying down on the back, bring one leg up and pull it towards the chest and hold for 30–45 seconds.
342:. However, the former is a clinical term, while the latter more specifically describes the condition of spinal narrowing.
1327:
to cover and protect nerves from damage, preventing pain induced from damaged nerve roots, as described in some cases of
246:
3939:"Effects of Nasal Calcitonin vs. Oral Gabapentin on Pain and Symptoms of Lumbar Spinal Stenosis: A Clinical Trial Study"
1525:. A history of spinal injuries or deformities is also a contributing factor to the increased likelihood of the onset of
1180:
knee to chest stretch, posterior pelvic tilt, neural stretching of the legs, hip-flexor stretch and lower trunk rotation
2840: “Lumbar/Core Strength and Stability Exercises”, Princeton University Athletic Medicine, accessed 2 October 2020,
2182:
Critchley E, Eisen A (1992). "Disc and
Degenerative Disease: Stenosis, Spondylosis and Subluxation". In Swash M (ed.).
1385:
190:
2363:
3573:"Factors associated with lumbar spinal stenosis in a large-scale, population-based cohort: The Wakayama Spine Study"
1572:
relative to this population group is 47.2%. Data obtained from medical practitioners suggest that the incidence of
2919:"The efficacy of physical therapy and physical therapy plus calcitonin in the treatment of lumbar spinal stenosis"
1166:. They may be considered for short-term pain relief or to delay surgery, but their benefit is considered small.
1072:. Pain with walking may be partially explained by the corresponding increase in nerve root oxygen requirements.
845:
419:
202:
2012:"Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis"
1554:
in elderly patients. Relative to their respective age groups, 16% of individuals aged less than 40 experience
4201:"Spinal Cord Changes After Laminoplasty in Cervical Compressive Myelopathy: A Diffusion Tensor Imaging Study"
3891:
Wise J (April 2015). "Physical therapy is as effective as surgery for lumbar spinal stenosis, study finds".
1388:, minimally invasive lumbar decompression (MILD) procedure, laminectomy, microdiscectomy and placement of a
789:
558:
are typically normal. Abnormal signs may be revealed if the patient is observed walking until they exhibit
478:
96:
1104:
2224:"Does this older adult with lower extremity pain have the clinical syndrome of lumbar spinal stenosis?"
1179:
1163:
625:
555:
503:
262:
122:
1400:. Laminectomy also involves partial or complete removal and sacrifice of the lamina, but in addition,
1134:
physical therapy, and spinal injections. Medication options for neurogenic claudication have included
1801:"A Review of Lumbar Spinal Stenosis with Intermittent Neurogenic Claudication: Disease and Diagnosis"
1006:
800:
601:
328:
186:
1461:
patients that develop worse symptoms over time, severe consequences can occur. Over time, untreated
3158:. CADTH Rapid Response Reports. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health.
2863:
Schneider MJ, Ammendolia C, Murphy DR, Glick RM, Hile E, Tudorascu DL, et al. (January 2019).
1674:
that suppresses nerve activity, has been in development for use in patents with back pain, such as
1509:
1125:(LSS) or other degenerative spinal diseases. Decreased walking and lower body motor ability due to
757:
547:
3783:
Machado GC, Ferreira PH, Harris IA, Pinheiro MB, Koes BW, van Tulder M, et al. (2015-03-30).
1314:
patients. Gabapentin aims to reduce pain and provide relief by altering the normal functioning of
3842:
Anderson DB, Ferreira ML, Harris IA, Davis GA, Stanford R, Beard D, et al. (February 2019).
2841:
2072:
Alvarez JA, Hardy RH (April 1998). "Lumbar spine stenosis: a common cause of back and leg pain".
1175:
1151:
90:
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can develop, disrupting sensory and motor function in the lower body and bladder. Consequently,
2444:
Ammendolia C, Schneider M, Williams K, Zickmund S, Hamm M, Stuber K, et al. (March 2017).
1716:
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Neurogenic claudication commonly describes pain, weakness, fatigue, tingling, heaviness and/or
482:
368:
294:
181:
130:
2446:"The physical and psychological impact of neurogenic claudication: the patients' perspectives"
4299:
Hirano Y, Ohara Y, Mizuno J, Itoh Y (January 2018). "History and
Evolution of Laminoplasty".
4085:
2971:"Physical therapy interventions for degenerative lumbar spinal stenosis: a systematic review"
2787:
Markman JD, Gewandter JS, Frazer ME, Pittman C, Cai X, Patel KV, et al. (October 2015).
1470:
1064:. In contrast, the venous stasis theory proposes that a combination of low oxygen levels and
855:
830:
637:
210:
3785:"Effectiveness of surgery for lumbar spinal stenosis: a systematic review and meta-analysis"
297:(LSS) and describes intermittent leg pain from impingement of the nerves emanating from the
3796:
3584:
1372:
1052:
It is currently unknown which exact cellular mechanisms within the body causes the pain of
1034:
850:
707:
621:
442:
206:
118:
47:
CT scan of spinal stenosis and thickened ligamentum flavum, causing neurogenic claudication
3844:"SUcceSS, SUrgery for Spinal Stenosis: protocol of a randomised, placebo-controlled trial"
3571:
Maeda T, Hashizume H, Yoshimura N, Oka H, Ishimoto Y, Nagata K, et al. (2018-07-18).
2579:"Current concepts and recent advances in understanding and managing lumbar spine stenosis"
2485:
Watanabe K, Sekiguchi M, Yonemoto K, Nikaido T, Kato K, Otani K, et al. (July 2017).
8:
2789:"Evaluation of outcome measures for neurogenic claudication: A patient-centered approach"
2355:
1731:
1679:
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and more explosive movements. Other exercises such as cycling (stationary), swimming and
1014:
835:
194:
3800:
3588:
3471:
Bydon M, Macki M, Abt NB, Sciubba DM, Wolinsky JP, Witham TF, et al. (2015-05-07).
1294:. The main goal of these medications is to reduce pain and provide temporary relief for
1109:
4511:
4494:
4475:
4411:
4386:
4362:
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3095:
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3019:
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2970:
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2889:
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2813:
2788:
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2712:
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2578:
2462:
2445:
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2385:
2319:
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2223:
2144:
2119:
2038:
2011:
1887:
1862:
1825:
1800:
1741:
1187:
551:
332:
72:
57:
3473:"Clinical and surgical outcomes after lumbar laminectomy: An analysis of 500 patients"
2880:
2577:
Bagley C, MacAllister M, Dosselman L, Moreno J, Aoun SG, El
Ahmadieh TY (2019-01-31).
1497:
can lead to potential disability, muscle weakness or constant pain in the lower body.
4516:
4467:
4416:
4387:"A Narrative Review of Lumbar Fusion Surgery With Relevance to Chiropractic Practice"
4367:
4316:
4273:
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3908:
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2554:
2508:
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2187:
2149:
2081:
2043:
1981:
1933:
1892:
1830:
1183:
1026:
388:
371:
or the central spinal canal. This definition reflects the current hypotheses for the
163:
52:
4479:
4285:
4185:
3433:
2764:
2716:
2323:
1584:
as a consequence of aging, heavily contributes to the epidemiology and acquiring of
4506:
4457:
4447:
4406:
4398:
4357:
4347:
4308:
4263:
4222:
4212:
4165:
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3814:
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3695:
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3535:
3494:
3484:
3413:
3375:
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3321:
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3272:
3231:
3221:
3155:
Gabapentin for Adults with
Neuropathic Pain: A Review of the Clinical Effectiveness
3090:
3082:
3041:
3031:
2990:
2982:
2938:
2930:
2884:
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2800:
2744:
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2600:
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2457:
2405:
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2235:
2139:
2131:
2033:
2023:
1971:
1923:
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1600:) and this incidence rate is also doubled in retirement communities. As the global
1331:. Epidural steroid injections are the main epidural injections prescribed to treat
1315:
805:
462:
226:
3447:
4462:
3809:
3751:
3647:
3597:
2804:
2748:
1601:
1376:
1234:
1191:
1147:
1088:
1030:
772:
753:
711:
628:. Less commonly, the cause of spinal stenosis may be present at birth as seen in
372:
348:
339:
258:
106:
78:
4495:"Spinal Fusion for Chronic Low Back Pain: A 'Magic Bullet' or Wishful Thinking?"
3859:
3736:"Spinal stenosis prevalence and association with symptoms: the Framingham Study"
2969:
Macedo LG, Hum A, Kuleba L, Mo J, Truong L, Yeung M, Battié MC (December 2013).
1257:
Common strengthening exercises used to treat and prevent future reocurrences of
1029:, and intervertebral discs. These pathologic changes result in narrowing of the
477:
imaging. In addition to vascular claudication, diseases affecting the spine and
4123:
3540:
3523:
3417:
3178:
3153:
3119:
3086:
2546:
2401:
2346:
Gala RJ, Yue JJ (2018). Reach J, Yue JJ, Narayan D, Kaye A, Vadivelu N (eds.).
1976:
1959:
1726:
1450:
has not been well reported and is unknown. Based on the physiological cause of
1347:
is necessary to allow doctors to provide better care and treatment options for
1303:
808:
629:
605:
359:
defines neurogenic claudication as, "pain from intermittent compression and/or
316:
306:
142:
110:
4402:
4312:
3734:
Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, Hunter DJ (July 2009).
3276:
2934:
2700:
2645:
2503:
2486:
2307:
77:
Pain, tingling, tiredness, weakness, numbness or heaviness in the legs, hips,
4534:
4352:
4217:
4058:
3549:
3489:
3370:
2653:
1878:
1477:
in the lower extremities may develop over time in individuals with untreated
1406:
1397:
1307:
1139:
817:
250:
214:
4268:
4251:
3448:"Neel Anand, MD - Professor of Orthopaedic Surgery Director of Spine Trauma"
2629:
1799:
Deer T, Sayed D, Michels J, Josephson Y, Li S, Calodney AK (December 2019).
1060:
theory proposes that poor blood supply to the spinal nerve roots results in
4520:
4471:
4420:
4371:
4320:
4277:
4236:
4142:
4077:
4026:
3972:
3912:
3877:
3828:
3769:
3709:
3665:
3616:
3508:
3425:
3389:
3335:
3294:
3245:
3188:
3163:
3129:
3104:
3055:
3004:
2952:
2898:
2822:
2756:
2708:
2661:
2614:
2558:
2512:
2471:
2419:
2315:
2257:
2239:
2153:
2047:
1985:
1937:
1896:
1834:
1746:
1736:
1695:
1530:
1393:
1359:
Depending on the cause and severity of the condition, surgical options for
1299:
1233:
Neural
Stretching of the legs - Lying on the back, bring one leg up with a
1069:
1010:
645:
633:
567:
563:
454:
311:
138:
126:
65:
4434:
Harris IA, Traeger A, Stanford R, Maher CG, Buchbinder R (December 2018).
4334:
Proietti L, Scaramuzzo L, Schiro' GR, Sessa S, Logroscino CA (July 2013).
4177:
3261:"Epidural steroid injection: a need for a new clinical practice guideline"
3226:
2085:
2028:
4252:"Future Advances in Spine Surgery: The AOSpine North America Perspective"
4007:
3954:
2986:
1721:
1522:
1401:
1375:
is considered the mainstay of surgical treatment. In this procedure, the
1038:
1022:
764:
641:
494:
446:
415:
384:
380:
298:
149:
114:
3326:
3309:
3020:"Nonsteroidal anti-inflammatory drugs in the treatment of low back pain"
1816:
338:
The term neurogenic claudication is sometimes used interchangeably with
4169:
4107:"Tanezumab: Therapy targeting nerve growth factor in pain pathogenesis"
3700:
3683:
1474:
1380:
1240:
1143:
1065:
1041:
585:
513:
Whilst these common symptoms are usually present in many patients with
450:
364:
254:
241:
4452:
4435:
3904:
3036:
2628:
Guha, Daipayan; Heary, Robert F.; Shamji, Mohammed F. (October 2015).
2135:
1928:
1911:
1430:
may be asymptomatic for many years before developing symptoms such as
640:. In addition to spinal stenosis, other lower back conditions such as
3118:
Pahwa R, Goyal A, Bansal P, Jialal I (2020). "Chronic Inflammation".
2685:
1667:
1159:
458:
402:
involve one or both legs and usually presents as some combination of
392:
323: 'to limp', refers to painful cramping or weakness in the legs.
266:
134:
61:
3522:
Mohamed A, El Sisi YB, Al Emam SE, Hussen MA, Saif DS (2020-07-13).
600:
are most commonly acquired and include degenerative changes such as
434:
have less disability in climbing steps, pushing carts, and cycling.
39:
3943:
Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders
3682:
Costandi S, Chopko B, Mekhail M, Dews T, Mekhail N (January 2015).
2443:
1671:
1195:
1080:
1057:
735:"Does the patient have motor or sensory disturbance while walking?"
702:
Neurogenic claudication is one subtype of the clinical syndrome of
411:
403:
360:
4333:
3991:"Tanezumab: a selective humanized mAb for chronic lower back pain"
998:
694:
4336:"Complications in lumbar spine surgery: A retrospective analysis"
3989:
Webb MP, Helander EM, Menard BL, Urman RD, Kaye AD (2018-02-21).
3630:
Sigmundsson FG, Kang XP, Jönsson B, Strömqvist B (October 2012).
840:
825:
732:"Does patient feel relief when using a shopping cart or bicycle?"
470:
427:
290:
270:
198:
169:
155:
3629:
3402:
2576:
2484:
1641:. Reports have shown that physical therapy does aid in treating
1392:. The MILD procedure aims to relieve spinal cord compression by
2348:
Perioperative Pain Management for Orthopaedic and Spine Surgery
1469:
can lead to chronic pain and muscle weakness. In severe cases,
1324:
1227:
821:
613:
578:
Neurogenic claudication is the fundamental clinical feature of
517:, rarer and more serious symptoms can occur in severe cases of
222:
82:
2862:
2842:
https://uhs.princeton.edu/sites/uhs/files/documents/Lumbar.pdf
2734:
1958:
Vining RD, Shannon ZK, Minkalis AL, Twist EJ (November 2019).
1230:, until the back is straight. Hold for 5–10 seconds and relax.
682:
Occupation involving repetitive mechanical stress on the spine
16:
Discomfort in the legs during walking due to nerve impingement
4385:
Daniels CJ, Wakefield PJ, Bub GA, Toombs JD (December 2016).
4250:
Fehlings MG, Ahuja CS, Mroz T, Hsu W, Harrop J (March 2017).
3782:
2786:
2293:
1678:. The drug functions by selectively targeting and inhibiting
1521:
is also more likely present in individuals with other spinal
1298:
patients. NSAIDs and prostaglandin-based medications control
749:
474:
407:
383:
nerve roots by surrounding structures, such as hypertrophied
217:(lumbar radiculopathy) and pain in other spinal structures:
173:
2545:
Munakomi, Sunil; Foris, Lisa A.; Varacallo, Matthew (2020),
2350:. United States: Oxford University Press. pp. 172–186.
3841:
3521:
3352:
Comer CM, Redmond AC, Bird HA, Conaghan PG (October 2009).
2222:
Suri P, Rainville J, Kalichman L, Katz JN (December 2010).
1215:
Common stretching exercises used to relieve pain and treat
1121:
aim to cure the underlying cause of the condition, such as
4433:
4199:
Yang YM, Yoo WK, Bashir S, Oh JK, Kwak YH, Kim SW (2018).
4042:"Tanezumab: Finally a Monoclonal Antibody for Pain Relief"
3570:
2221:
1957:
1863:"Lumbar Stenosis: A Recent Update by Review of Literature"
1178:(core) and leg muscles. Common stretches used include the
726:"Does the patient have leg or buttock pain while walking?"
4384:
3681:
2916:
1798:
1604:
increases, the impact of spinal disease symptoms such as
1002:
Degenerative changes cause compression of the spinal cord
768:
748:
The physical exam may include observation, evaluation of
218:
3351:
2917:
Sahin F, Yilmaz F, Kotevoglu N, Kuran B (October 2009).
3988:
3310:"Systemic Effects of Epidural Corticosteroid Injection"
1861:
Lee SY, Kim TH, Oh JK, Lee SJ, Park MS (October 2015).
1323:
patients with temporary pain-relief. The drug produces
379:, which is thought to be related to the compression of
3632:"Prognostic factors in lumbar spinal stenosis surgery"
3117:
2544:
1964:
Journal of Manipulative and Physiological Therapeutics
861:
719:
above the knees, and a positive "shopping cart sign".
422:
may be present. Classically, the symptoms and pain of
4298:
4155:
3936:
3210:"Methylcobalamin: a potential vitamin of pain killer"
3177:
Yasaei R, Katta S, Saadabadi A (2020). "Gabapentin".
1578:
is 5 cases per 100 000. This increased prevalence of
1485:. Whilst some patients may recover and improve their
4249:
3684:"Lumbar spinal stenosis: therapeutic options review"
3470:
3176:
2450:
The Journal of the Canadian Chiropractic Association
1560:
whilst 38.8% of individuals aged over 60 experience
1068:
buildup are responsible due to venous backup at the
729:"Does the patient flex forward to relieve symptoms?"
535:
rather than the condition itself. As most causes of
3068:
2390:
Best Practice & Research. Clinical Rheumatology
1566:. Between the ages of 60 and 69, the prevalence of
1302:at sites of nerve damage or pressure by inhibiting
738:"Are the pulses in the foot present and symmetric?"
722:Specific questions that may aid diagnosis include:
418:and ability in the lower body can be observed, and
3733:
3075:Arteriosclerosis, Thrombosis, and Vascular Biology
1075:These changes in blood flow may occur during back
4090:: CS1 maint: DOI inactive as of September 2024 (
2968:
2117:
1396:removal of portions of the ligamentum flavum and
1379:is first removed, followed by the removal of the
1018:
820:from spinal structures, hip or sacroiliac joint,
741:"Does the patient have lower extremity weakness?"
4532:
4111:Journal of Anaesthesiology Clinical Pharmacology
3406:Archives of Physical Medicine and Rehabilitation
2186:. Hong Kong: Springer London. pp. 157–180.
1339:. Whilst the use of medications is common among
4198:
3307:
3183:. Treasure Island (FL): StatPearls Publishing.
3124:. Treasure Island (FL): StatPearls Publishing.
2627:
2553:, Treasure Island (FL): StatPearls Publishing,
1704:
1700:
1691:
1675:
1662:
1650:
1646:
1642:
1638:
1626:
1622:
1617:
1605:
1597:
1593:
1589:
1585:
1545:
1538:
1534:
1526:
1518:
1514:
1505:
1494:
1490:
1486:
1478:
1462:
1458:
1451:
1447:
1439:
1431:
1368:
1360:
1348:
1344:
1340:
1336:
1332:
1328:
1320:
1311:
1295:
1291:
1258:
1216:
1204:
1200:
1130:
1126:
1118:
1061:
1053:
1045:
987:
983:
793:
777:
715:
698:MRI of the lumbar spine showing spinal stenosis
653:
593:
559:
543:
536:
532:
527:
522:
518:
514:
498:
438:
431:
423:
399:
395:, scar tissue, and bulging or herniated discs.
376:
357:International Association for the Study of Pain
352:
343:
324:
4104:
3937:Haddadi K, Asadian L, Isazade A (2016-01-01).
3017:
2181:
1580:
1574:
1568:
1562:
1556:
1550:
1482:
1466:
1443:
1435:
1427:
1415:
1364:
1155:
1136:non-steroidal anti-inflammatory drugs (NSAIDs)
1092:
660:
609:
597:
589:
580:
3308:King W, Miller DC, Smith CC (February 2018).
2547:"Spinal Stenosis And Neurogenic Claudication"
305:means that the problem originates within the
4436:"Lumbar spine fusion: what is the evidence?"
3207:
3201:
3151:
2383:
2071:
1696:Laminoplastie en bloc expansive Laminoplasty
1860:
1533:have also been found to be associated with
689:
4105:Patel MK, Kaye AD, Urman RD (2018-01-01).
1690:Whilst surgical procedures exist to treat
1588:. Among individuals with spinal stenosis,
1252:
158:, previous spinal deformities or problems.
38:
4510:
4461:
4451:
4410:
4361:
4351:
4267:
4226:
4216:
4132:
4122:
4067:
4057:
4016:
4006:
3995:Therapeutics and Clinical Risk Management
3962:
3867:
3818:
3808:
3759:
3699:
3655:
3606:
3596:
3539:
3498:
3488:
3379:
3369:
3325:
3284:
3235:
3225:
3094:
3045:
3035:
2994:
2942:
2888:
2812:
2604:
2594:
2502:
2461:
2409:
2247:
2143:
2037:
2027:
2009:
1975:
1927:
1886:
1824:
1354:
1306:activity, and reducing the production of
783:
685:Past deformities or injuries to the spine
2184:Clinical Medicine and the Nervous System
2118:Lurie J, Tomkins-Lane C (January 2016).
1113:Spinal injection into the epidural space
1108:
1105:Lumbar spinal stenosis § Management
1091:. The amount of narrowing may be 67% in
1079:when shifts in vertebral structures and
997:
763:Helpful imaging may include x-rays, CT,
693:
426:are relieved by a change in position or
4492:
3069:Ricciotti E, FitzGerald GA (May 2011).
2345:
2289:
2287:
1210:
542:On physical examination, patients with
430:of the waist. Therefore, patients with
327:should therefore be distinguished from
168:Physical examination, medical imaging (
4541:Nerve, nerve root and plexus disorders
4533:
3984:
3982:
3932:
3930:
3729:
3727:
3677:
3675:
3347:
3345:
3147:
3145:
2964:
2962:
2912:
2910:
2908:
2836:
2834:
2832:
2379:
2377:
2375:
2285:
2283:
2281:
2279:
2277:
2275:
2273:
2271:
2269:
2267:
2120:"Management of lumbar spinal stenosis"
1909:
1794:
1792:
1790:
1788:
1786:
1784:
1782:
1685:
1493:. In most scenarios, the prognosis of
1154:are administered to treat symptoms of
744:"Does the patient have low back pain?"
236:Physical therapy, medications, surgery
4301:Neurosurgery Clinics of North America
2858:
2856:
2854:
2852:
2850:
2782:
2780:
2778:
2776:
2774:
2730:
2728:
2726:
2681:
2679:
2677:
2675:
2673:
2671:
2540:
2538:
2536:
2534:
2532:
2530:
2528:
2526:
2524:
2522:
2439:
2437:
2435:
2433:
2431:
2429:
2341:
2339:
2337:
2335:
2333:
2217:
2215:
2213:
2211:
2209:
2207:
2205:
2203:
2113:
2111:
2109:
2107:
2105:
2103:
2101:
2099:
2097:
2095:
1953:
1951:
1949:
1947:
1856:
1854:
1852:
1850:
1848:
1846:
1844:
1780:
1778:
1776:
1774:
1772:
1770:
1768:
1766:
1764:
1762:
1632:
1529:. Other factors such as exercise and
488:
247:Non-steroidal anti-inflammatory drugs
4039:
3890:
3258:
3018:Kuritzky L, Samraj GP (2012-11-28).
2177:
2175:
2173:
2171:
2169:
2167:
2165:
2163:
2067:
2065:
2063:
2061:
2059:
2057:
2005:
2003:
2001:
1999:
1997:
1995:
867:Neurogenic vs Vascular Claudication
3979:
3927:
3724:
3672:
3342:
3208:Zhang M, Han W, Hu S, Xu H (2013).
3142:
2959:
2905:
2829:
2372:
2264:
1661:Medications commonly prescribed to
1611:
1169:
862:Neurogenic vs vascular claudication
546:have normal peripheral pulses. The
13:
2847:
2771:
2723:
2668:
2519:
2426:
2384:Genevay S, Atlas SJ (April 2010).
2356:10.1093/med/9780190626761.001.0001
2330:
2200:
2092:
1944:
1841:
1759:
1319:system to reduce pain and provide
1095:compared to 9% in healthy spines.
993:
335:problem rather than a neural one.
14:
4552:
4046:Indian Journal of Palliative Care
3071:"Prostaglandins and inflammation"
2881:10.1001/jamanetworkopen.2018.6828
2296:Current Pain and Headache Reports
2160:
2054:
1992:
1013:of neurogenic claudication. When
792:. The differential diagnosis for
714:. The accuracy of a diagnosis of
676:Family history of spinal stenosis
670:Degenerative changes of the spine
4391:Journal of Chiropractic Medicine
3528:Egyptian Journal of Neurosurgery
3477:Surgical Neurology International
1656:
769:magnetic resonance imaging (MRI)
4486:
4427:
4378:
4327:
4292:
4243:
4192:
4149:
4098:
4033:
3884:
3835:
3776:
3623:
3564:
3515:
3464:
3440:
3396:
3301:
3252:
3170:
3111:
3062:
3011:
2621:
2570:
2478:
1500:
1017:degenerate and change shape in
4340:Indian Journal of Orthopaedics
2596:10.12688/f1000research.16082.1
2491:Journal of Orthopaedic Science
1903:
1616:Current treatment options for
1284:
846:Vertebral compression fracture
203:vertebral compression fracture
1:
4499:Malaysian Orthopaedic Journal
3358:BMC Musculoskeletal Disorders
1752:
3810:10.1371/journal.pone.0122800
3752:10.1016/j.spinee.2009.03.005
3648:10.3109/17453674.2012.733915
3598:10.1371/journal.pone.0200208
2805:10.1212/WNL.0000000000002000
2749:10.1097/BRS.0b013e318240d57d
2016:World Journal of Orthopedics
1421:
1418:have yielded mixed results.
1386:interspinous process spacers
1098:
588:or acquired. As a result of
506:and improvement with spinal
481:should be considered in the
420:bowel or bladder dysfunction
398:The predominant symptoms of
97:bowel or bladder dysfunction
7:
3860:10.1136/bmjopen-2018-024944
3152:Narain T, Adcock L (2018).
1912:"(Neurogenic) Claudication"
1710:
1438:patients that present with
1158:. Preparations may contain
650:herniated or ruptured discs
131:herniated or ruptured disks
10:
4557:
4158:International Orthopaedics
4124:10.4103/joacp.JOACP_389_15
3541:10.1186/s41984-020-00087-6
3418:10.1016/j.apmr.2018.05.014
3265:The Korean Journal of Pain
3087:10.1161/ATVBAHA.110.207449
2402:10.1016/j.berh.2009.11.001
2010:Kobayashi S (April 2014).
1977:10.1016/j.jmpt.2019.08.002
1544:One of the main causes of
1373:Lower Spinal Decompression
1102:
752:in the foot, lumbar spine
4493:Dhillon KS (March 2016).
4440:Internal Medicine Journal
4403:10.1016/j.jcm.2016.08.007
4313:10.1016/j.nec.2017.09.019
3277:10.3344/kjp.2014.27.3.197
2935:10.3349/ymj.2009.50.5.683
2701:10.1007/s00586-014-3262-6
2646:10.3171/2015.7.FOCUS15259
2504:10.1016/j.jos.2017.04.006
2308:10.1007/s11916-019-0769-x
2074:American Family Physician
1381:superior facet osteophyte
1140:prostaglandin-based drugs
1007:Degenerative disc disease
602:degenerative disc disease
573:
251:prostaglandin-based drugs
240:
232:
215:Lumbar radicular syndrome
180:
162:
148:
102:
89:
71:
51:
46:
37:
29:
24:
4353:10.4103/0019-5413.114909
4218:10.3389/fneur.2018.00696
4059:10.4103/IJPC.IJPC_208_17
3490:10.4103/2152-7806.156578
3371:10.1186/1471-2474-10-121
3024:Journal of Pain Research
2386:"Lumbar spinal stenosis"
1879:10.4184/asj.2015.9.5.818
690:Diagnosis and Evaluation
471:Computer Tomography (CT)
363:of a single or multiple
4062:(inactive 2024-09-12).
2080:(8): 1825–34, 1839–40.
1608:is likely to increase.
1407:spinal fusion surgeries
1253:Strengthening Exercises
1085:intervertebral foramina
279:Neurogenic claudication
25:Neurogenic Claudication
4205:Frontiers in Neurology
2923:Yonsei Medical Journal
2689:European Spine Journal
2240:10.1001/jama.2010.1833
1717:Lumbar spinal stenosis
1471:caudea equina syndrome
1390:spinal cord stimulator
1355:Surgical Interventions
1192:water-based activities
1123:lumbar spinal stenosis
1117:Treatment options for
1114:
1009:(DDD) may trigger the
1003:
790:musculoskeletal system
784:Differential diagnosis
780:has been conflicting.
756:, and components of a
704:lumbar spinal stenosis
699:
618:ankylosing spondylitis
521:. In extreme cases of
483:differential diagnosis
479:musculoskeletal system
437:Treatment options for
369:intervertebral foramen
295:lumbar spinal stenosis
182:Differential diagnosis
107:Lumbar spinal stenosis
4463:1959.4/unsworks_75083
4269:10.1093/neuros/nyw112
3259:Leem JG (July 2014).
2029:10.5312/wjo.v5.i2.134
1112:
1001:
856:Peripheral neuropathy
831:Trochanteric bursitis
801:Vascular claudication
697:
638:mucopolysaccharidoses
556:femoral nerve stretch
331:, which stems from a
329:vascular claudication
289:, is the most common
211:peripheral neuropathy
191:trochanteric bursitis
187:Vascular claudication
4008:10.2147/TCRM.S144125
3955:10.4137/CMAMD.S39938
3412:(12): 2408–2419.e2.
2987:10.2522/ptj.20120379
1811:(Suppl 2): S32–S44.
1680:Nerve Growth Factors
1211:Stretching Exercises
1015:intervertebral discs
851:Compartment syndrome
811:secondary to lumbar
622:rheumatoid arthritis
443:Spinal decompression
207:compartment syndrome
119:rheumatoid arthritis
3801:2015PLoSO..1022800M
3589:2018PLoSO..1300208M
3483:(Suppl 4): S190-3.
3227:10.1155/2013/424651
2634:Neurosurgical Focus
1867:Asian Spine Journal
1732:Lumbar disc disease
1686:Surgical Procedures
1184:resistance training
1152:epidural injections
1037:compression at the
868:
836:Piriformis syndrome
263:epidural injections
195:piriformis syndrome
4170:10.1007/BF00178765
3701:10.1111/papr.12188
1916:European Neurology
1910:Pearce JM (2005).
1742:Orthopedic surgery
1363:vary. Symptoms of
1115:
1004:
970:Peripheral pulses
940:Extends down legs
937:Radiation of pain
892:Standing, walking
866:
700:
552:straight leg raise
489:Signs and Symptoms
410:discomfort, pain,
287:pseudoclaudication
33:Pseudoclaudication
4453:10.1111/imj.14120
4446:(12): 1430–1434.
3905:10.1136/bmj.h1827
3740:The Spine Journal
3636:Acta Orthopaedica
3327:10.1093/pm/pnx173
3214:Neural Plasticity
3037:10.2147/JPR.S6775
2869:JAMA Network Open
2193:978-1-4471-3353-7
2136:10.1136/bmj.h6234
1929:10.1159/000088648
1817:10.1093/pm/pnz161
1541:as aging occurs.
1426:Individuals with
1377:ligamentum flavum
1316:neurotransmitters
1207:to be necessary.
1027:ligamentum flavum
980:
979:
915:Timing of relief
900:Pain relieved by
884:
879:
874:
758:neurological exam
659:Risk factors for
648:, infections and
389:ligamentum flavum
285:), also known as
276:
275:
164:Diagnostic method
19:Medical condition
4548:
4525:
4524:
4514:
4490:
4484:
4483:
4465:
4455:
4431:
4425:
4424:
4414:
4382:
4376:
4375:
4365:
4355:
4331:
4325:
4324:
4296:
4290:
4289:
4271:
4247:
4241:
4240:
4230:
4220:
4196:
4190:
4189:
4153:
4147:
4146:
4136:
4126:
4102:
4096:
4095:
4089:
4081:
4071:
4061:
4040:Nair AS (2018).
4037:
4031:
4030:
4020:
4010:
3986:
3977:
3976:
3966:
3934:
3925:
3924:
3888:
3882:
3881:
3871:
3839:
3833:
3832:
3822:
3812:
3780:
3774:
3773:
3763:
3731:
3722:
3721:
3703:
3679:
3670:
3669:
3659:
3627:
3621:
3620:
3610:
3600:
3568:
3562:
3561:
3543:
3519:
3513:
3512:
3502:
3492:
3468:
3462:
3461:
3459:
3458:
3444:
3438:
3437:
3400:
3394:
3393:
3383:
3373:
3349:
3340:
3339:
3329:
3305:
3299:
3298:
3288:
3256:
3250:
3249:
3239:
3229:
3205:
3199:
3198:
3196:
3195:
3174:
3168:
3167:
3149:
3140:
3139:
3137:
3136:
3115:
3109:
3108:
3098:
3066:
3060:
3059:
3049:
3039:
3015:
3009:
3008:
2998:
2975:Physical Therapy
2966:
2957:
2956:
2946:
2914:
2903:
2902:
2892:
2860:
2845:
2838:
2827:
2826:
2816:
2784:
2769:
2768:
2732:
2721:
2720:
2683:
2666:
2665:
2625:
2619:
2618:
2608:
2598:
2574:
2568:
2567:
2566:
2565:
2542:
2517:
2516:
2506:
2482:
2476:
2475:
2465:
2441:
2424:
2423:
2413:
2381:
2370:
2369:
2343:
2328:
2327:
2291:
2262:
2261:
2251:
2219:
2198:
2197:
2179:
2158:
2157:
2147:
2115:
2090:
2089:
2069:
2052:
2051:
2041:
2031:
2007:
1990:
1989:
1979:
1955:
1942:
1941:
1931:
1907:
1901:
1900:
1890:
1858:
1839:
1838:
1828:
1796:
1706:
1702:
1693:
1677:
1664:
1652:
1648:
1644:
1640:
1633:Physical Therapy
1628:
1624:
1619:
1612:Current research
1607:
1599:
1595:
1591:
1587:
1582:
1576:
1570:
1564:
1558:
1552:
1548:is the onset of
1547:
1540:
1536:
1528:
1520:
1516:
1507:
1496:
1492:
1488:
1484:
1480:
1468:
1464:
1460:
1453:
1449:
1445:
1441:
1437:
1434:. However, most
1433:
1429:
1417:
1370:
1366:
1362:
1350:
1346:
1342:
1338:
1334:
1330:
1322:
1313:
1297:
1293:
1260:
1218:
1206:
1202:
1170:Physical Therapy
1157:
1132:
1128:
1120:
1094:
1063:
1055:
1047:
1020:
989:
985:
948:Quality of pain
943:Extends up legs
932:Below the knees
929:Above the knees
889:Pain worse with
882:
877:
873:Clinical feature
872:
869:
865:
795:
779:
717:
662:
655:
611:
599:
596:. The causes of
595:
591:
582:
561:
545:
538:
534:
529:
524:
520:
516:
500:
440:
433:
425:
401:
378:
354:
345:
326:
227:sacroiliac joint
42:
22:
21:
4556:
4555:
4551:
4550:
4549:
4547:
4546:
4545:
4531:
4530:
4529:
4528:
4491:
4487:
4432:
4428:
4383:
4379:
4332:
4328:
4297:
4293:
4248:
4244:
4197:
4193:
4154:
4150:
4103:
4099:
4083:
4082:
4038:
4034:
3987:
3980:
3935:
3928:
3889:
3885:
3840:
3836:
3795:(3): e0122800.
3781:
3777:
3732:
3725:
3680:
3673:
3628:
3624:
3583:(7): e0200208.
3569:
3565:
3520:
3516:
3469:
3465:
3456:
3454:
3446:
3445:
3441:
3401:
3397:
3350:
3343:
3306:
3302:
3257:
3253:
3206:
3202:
3193:
3191:
3175:
3171:
3150:
3143:
3134:
3132:
3116:
3112:
3081:(5): 986–1000.
3067:
3063:
3016:
3012:
2981:(12): 1646–60.
2967:
2960:
2915:
2906:
2861:
2848:
2839:
2830:
2785:
2772:
2743:(10): E609-16.
2733:
2724:
2695:(6): 1282–301.
2684:
2669:
2626:
2622:
2575:
2571:
2563:
2561:
2543:
2520:
2483:
2479:
2442:
2427:
2382:
2373:
2366:
2344:
2331:
2292:
2265:
2234:(23): 2628–36.
2220:
2201:
2194:
2180:
2161:
2116:
2093:
2070:
2055:
2008:
1993:
1956:
1945:
1908:
1904:
1859:
1842:
1797:
1760:
1755:
1713:
1688:
1670:, a monoclonal
1659:
1635:
1614:
1602:life expectancy
1510:noncommunicable
1503:
1424:
1357:
1287:
1255:
1235:stretching band
1213:
1172:
1148:methylcobalamin
1107:
1101:
1089:spinal stenosis
1031:vertebral canal
996:
994:Pathophysiology
954:Cramping, dull
918:Within minutes
864:
813:disc herniation
786:
773:spinal stenosis
754:range of motion
712:medical imaging
692:
626:Paget's disease
584:, which may be
576:
548:neurologic exam
491:
451:microdiscectomy
373:pathophysiology
340:spinal stenosis
259:methylcobalamin
123:Paget's disease
20:
17:
12:
11:
5:
4554:
4544:
4543:
4527:
4526:
4485:
4426:
4397:(4): 259–271.
4377:
4326:
4307:(1): 107–113.
4291:
4242:
4191:
4148:
4117:(1): 111–116.
4097:
4052:(3): 384–385.
4032:
3978:
3926:
3883:
3854:(2): e024944.
3834:
3775:
3723:
3671:
3622:
3563:
3514:
3463:
3439:
3395:
3341:
3320:(2): 404–405.
3300:
3251:
3200:
3169:
3141:
3110:
3061:
3010:
2958:
2904:
2875:(1): e186828.
2846:
2828:
2799:(14): 1250–6.
2770:
2722:
2667:
2620:
2569:
2518:
2497:(4): 647–651.
2477:
2425:
2371:
2364:
2329:
2263:
2199:
2192:
2159:
2091:
2053:
1991:
1970:(9): 651–664.
1943:
1902:
1840:
1757:
1756:
1754:
1751:
1750:
1749:
1744:
1739:
1734:
1729:
1727:Spinal disease
1724:
1719:
1712:
1709:
1687:
1684:
1658:
1655:
1634:
1631:
1613:
1610:
1502:
1499:
1423:
1420:
1356:
1353:
1308:prostaglandins
1304:cyclooxygenase
1286:
1283:
1282:
1281:
1277:
1274:
1271:
1267:
1254:
1251:
1250:
1249:
1245:
1238:
1231:
1224:
1212:
1209:
1171:
1168:
1100:
1097:
995:
992:
978:
977:
976:May be absent
974:
971:
967:
966:
963:
960:
956:
955:
952:
949:
945:
944:
941:
938:
934:
933:
930:
927:
923:
922:
919:
916:
912:
911:
908:
901:
897:
896:
893:
890:
886:
885:
880:
875:
863:
860:
859:
858:
853:
848:
843:
838:
833:
828:
815:
809:radicular pain
803:
785:
782:
746:
745:
742:
739:
736:
733:
730:
727:
691:
688:
687:
686:
683:
680:
677:
674:
671:
668:
636:, and certain
630:achondroplasia
606:osteoarthritis
575:
572:
490:
487:
459:pain relievers
416:motor function
307:nervous system
274:
273:
244:
238:
237:
234:
230:
229:
184:
178:
177:
166:
160:
159:
152:
146:
145:
143:achondroplasia
111:osteoarthritis
104:
100:
99:
93:
87:
86:
75:
69:
68:
55:
49:
48:
44:
43:
35:
34:
31:
27:
26:
18:
15:
9:
6:
4:
3:
2:
4553:
4542:
4539:
4538:
4536:
4522:
4518:
4513:
4508:
4504:
4500:
4496:
4489:
4481:
4477:
4473:
4469:
4464:
4459:
4454:
4449:
4445:
4441:
4437:
4430:
4422:
4418:
4413:
4408:
4404:
4400:
4396:
4392:
4388:
4381:
4373:
4369:
4364:
4359:
4354:
4349:
4345:
4341:
4337:
4330:
4322:
4318:
4314:
4310:
4306:
4302:
4295:
4287:
4283:
4279:
4275:
4270:
4265:
4262:(3S): S1–S8.
4261:
4257:
4253:
4246:
4238:
4234:
4229:
4224:
4219:
4214:
4210:
4206:
4202:
4195:
4187:
4183:
4179:
4175:
4171:
4167:
4164:(3): 309–14.
4163:
4159:
4152:
4144:
4140:
4135:
4130:
4125:
4120:
4116:
4112:
4108:
4101:
4093:
4087:
4079:
4075:
4070:
4065:
4060:
4055:
4051:
4047:
4043:
4036:
4028:
4024:
4019:
4014:
4009:
4004:
4000:
3996:
3992:
3985:
3983:
3974:
3970:
3965:
3960:
3956:
3952:
3948:
3944:
3940:
3933:
3931:
3922:
3918:
3914:
3910:
3906:
3902:
3898:
3894:
3887:
3879:
3875:
3870:
3865:
3861:
3857:
3853:
3849:
3845:
3838:
3830:
3826:
3821:
3816:
3811:
3806:
3802:
3798:
3794:
3790:
3786:
3779:
3771:
3767:
3762:
3757:
3753:
3749:
3746:(7): 545–50.
3745:
3741:
3737:
3730:
3728:
3719:
3715:
3711:
3707:
3702:
3697:
3693:
3689:
3688:Pain Practice
3685:
3678:
3676:
3667:
3663:
3658:
3653:
3649:
3645:
3642:(5): 536–42.
3641:
3637:
3633:
3626:
3618:
3614:
3609:
3604:
3599:
3594:
3590:
3586:
3582:
3578:
3574:
3567:
3559:
3555:
3551:
3547:
3542:
3537:
3533:
3529:
3525:
3518:
3510:
3506:
3501:
3496:
3491:
3486:
3482:
3478:
3474:
3467:
3453:
3452:SpineUniverse
3449:
3443:
3435:
3431:
3427:
3423:
3419:
3415:
3411:
3407:
3399:
3391:
3387:
3382:
3377:
3372:
3367:
3363:
3359:
3355:
3348:
3346:
3337:
3333:
3328:
3323:
3319:
3315:
3314:Pain Medicine
3311:
3304:
3296:
3292:
3287:
3282:
3278:
3274:
3270:
3266:
3262:
3255:
3247:
3243:
3238:
3233:
3228:
3223:
3219:
3215:
3211:
3204:
3190:
3186:
3182:
3181:
3173:
3165:
3161:
3157:
3156:
3148:
3146:
3131:
3127:
3123:
3122:
3114:
3106:
3102:
3097:
3092:
3088:
3084:
3080:
3076:
3072:
3065:
3057:
3053:
3048:
3043:
3038:
3033:
3029:
3025:
3021:
3014:
3006:
3002:
2997:
2992:
2988:
2984:
2980:
2976:
2972:
2965:
2963:
2954:
2950:
2945:
2940:
2936:
2932:
2928:
2924:
2920:
2913:
2911:
2909:
2900:
2896:
2891:
2886:
2882:
2878:
2874:
2870:
2866:
2859:
2857:
2855:
2853:
2851:
2843:
2837:
2835:
2833:
2824:
2820:
2815:
2810:
2806:
2802:
2798:
2794:
2790:
2783:
2781:
2779:
2777:
2775:
2766:
2762:
2758:
2754:
2750:
2746:
2742:
2738:
2731:
2729:
2727:
2718:
2714:
2710:
2706:
2702:
2698:
2694:
2690:
2682:
2680:
2678:
2676:
2674:
2672:
2663:
2659:
2655:
2651:
2647:
2643:
2639:
2635:
2631:
2624:
2616:
2612:
2607:
2602:
2597:
2592:
2588:
2584:
2583:F1000Research
2580:
2573:
2560:
2556:
2552:
2548:
2541:
2539:
2537:
2535:
2533:
2531:
2529:
2527:
2525:
2523:
2514:
2510:
2505:
2500:
2496:
2492:
2488:
2481:
2473:
2469:
2464:
2459:
2455:
2451:
2447:
2440:
2438:
2436:
2434:
2432:
2430:
2421:
2417:
2412:
2407:
2403:
2399:
2396:(2): 253–65.
2395:
2391:
2387:
2380:
2378:
2376:
2367:
2365:9780190626761
2361:
2357:
2353:
2349:
2342:
2340:
2338:
2336:
2334:
2325:
2321:
2317:
2313:
2309:
2305:
2301:
2297:
2290:
2288:
2286:
2284:
2282:
2280:
2278:
2276:
2274:
2272:
2270:
2268:
2259:
2255:
2250:
2245:
2241:
2237:
2233:
2229:
2225:
2218:
2216:
2214:
2212:
2210:
2208:
2206:
2204:
2195:
2189:
2185:
2178:
2176:
2174:
2172:
2170:
2168:
2166:
2164:
2155:
2151:
2146:
2141:
2137:
2133:
2129:
2125:
2121:
2114:
2112:
2110:
2108:
2106:
2104:
2102:
2100:
2098:
2096:
2087:
2083:
2079:
2075:
2068:
2066:
2064:
2062:
2060:
2058:
2049:
2045:
2040:
2035:
2030:
2025:
2022:(2): 134–45.
2021:
2017:
2013:
2006:
2004:
2002:
2000:
1998:
1996:
1987:
1983:
1978:
1973:
1969:
1965:
1961:
1954:
1952:
1950:
1948:
1939:
1935:
1930:
1925:
1921:
1917:
1913:
1906:
1898:
1894:
1889:
1884:
1880:
1876:
1873:(5): 818–28.
1872:
1868:
1864:
1857:
1855:
1853:
1851:
1849:
1847:
1845:
1836:
1832:
1827:
1822:
1818:
1814:
1810:
1806:
1805:Pain Medicine
1802:
1795:
1793:
1791:
1789:
1787:
1785:
1783:
1781:
1779:
1777:
1775:
1773:
1771:
1769:
1767:
1765:
1763:
1758:
1748:
1745:
1743:
1740:
1738:
1735:
1733:
1730:
1728:
1725:
1723:
1720:
1718:
1715:
1714:
1708:
1697:
1683:
1681:
1673:
1669:
1654:
1630:
1609:
1603:
1583:
1577:
1571:
1565:
1559:
1553:
1542:
1532:
1524:
1523:comorbidities
1511:
1498:
1476:
1472:
1455:
1419:
1411:
1408:
1403:
1399:
1395:
1391:
1387:
1382:
1378:
1374:
1352:
1326:
1317:
1309:
1305:
1301:
1278:
1275:
1272:
1268:
1264:
1263:
1262:
1246:
1242:
1239:
1236:
1232:
1229:
1225:
1222:
1221:
1220:
1208:
1197:
1193:
1189:
1188:gym equipment
1185:
1181:
1177:
1167:
1165:
1161:
1153:
1149:
1145:
1141:
1137:
1124:
1111:
1106:
1096:
1090:
1086:
1082:
1078:
1073:
1071:
1067:
1059:
1050:
1043:
1040:
1036:
1035:neurovascular
1032:
1028:
1024:
1016:
1012:
1008:
1000:
991:
975:
972:
969:
968:
964:
961:
958:
957:
953:
950:
947:
946:
942:
939:
936:
935:
931:
928:
925:
924:
920:
917:
914:
913:
909:
906:
902:
899:
898:
894:
891:
888:
887:
881:
876:
871:
870:
857:
854:
852:
849:
847:
844:
842:
839:
837:
834:
832:
829:
827:
823:
819:
818:Referred pain
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810:
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708:gold standard
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696:
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94:
92:
91:Complications
88:
84:
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76:
74:
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4259:
4256:Neurosurgery
4255:
4245:
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4204:
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4100:
4086:cite journal
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3687:
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3566:
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3455:. Retrieved
3451:
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3409:
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3398:
3361:
3357:
3317:
3313:
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3271:(3): 197–9.
3268:
3264:
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3192:. Retrieved
3179:
3172:
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3133:. Retrieved
3120:
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3078:
3074:
3064:
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3013:
2978:
2974:
2929:(5): 683–8.
2926:
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2740:
2736:
2692:
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2637:
2633:
2623:
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2562:, retrieved
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2494:
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2456:(1): 18–31.
2453:
2449:
2393:
2389:
2347:
2299:
2295:
2231:
2227:
2183:
2127:
2123:
2077:
2073:
2019:
2015:
1967:
1963:
1922:(2): 118–9.
1919:
1915:
1905:
1870:
1866:
1808:
1804:
1747:Neurosurgery
1737:Claudication
1689:
1660:
1636:
1615:
1543:
1531:bone density
1504:
1501:Epidemiology
1456:
1425:
1412:
1394:percutaneous
1367:, including
1358:
1300:inflammation
1288:
1256:
1214:
1173:
1116:
1074:
1070:cauda equina
1051:
1023:facet joints
1011:pathogenesis
1005:
981:
921:Immediately
787:
765:CT myelogram
762:
747:
721:
701:
658:
634:spina bifida
577:
564:sensory loss
541:
512:
495:paresthesias
492:
468:
455:laminoplasty
436:
397:
385:facet joints
337:
320:
312:Claudication
310:
302:
286:
282:
278:
277:
150:Risk factors
127:spinal tumor
66:Neurosurgery
4001:: 361–367.
1722:Spondylosis
1657:Medications
1285:Medications
1186:(weights),
1042:nerve roots
1039:lumbosacral
841:Muscle pain
806:Lumbosacral
679:Tobacco use
642:spondylosis
604:and spinal
447:laminectomy
381:lumbosacral
365:nerve roots
333:circulatory
315:, from
299:spinal cord
199:muscle pain
115:spondylosis
58:Orthopedics
30:Other names
3457:2020-11-14
3364:(1): 121.
3220:: 424651.
3194:2020-11-15
3180:StatPearls
3135:2020-11-15
3121:StatPearls
3030:: 579–90.
2564:2020-11-20
2551:StatPearls
1753:References
1707:patients.
1475:disability
1351:patients.
1280:the chest.
1241:Hip-flexor
1144:gabapentin
1103:See also:
1066:metabolite
965:Sometimes
959:Back pain
907:, sitting
878:Neurogenic
796:includes:
706:(LSS). No
652:can cause
586:congenital
393:bone spurs
367:within an
321:claudicare
303:Neurogenic
255:gabapentin
242:Medication
83:lower back
3949:: 133–8.
3921:206904981
3899:: h1827.
3718:206246340
3558:220507514
3550:2520-8225
3534:(1): 19.
2793:Neurology
2654:1092-0684
2640:(4): E9.
2302:(5): 32.
2130:: h6234.
1668:Tanezumab
1422:Prognosis
1261:include:
1219:include:
1196:ligaments
1176:abdominal
1160:lidocaine
1099:Treatment
1081:ligaments
1077:extension
926:Location
910:Standing
822:myofascia
663:include:
570:changes.
504:extension
267:lidocaine
233:Treatment
223:myofascia
135:scoliosis
62:Neurology
53:Specialty
4535:Category
4521:28435551
4480:54524476
4472:30517997
4421:27857634
4372:23960276
4321:29173422
4286:25153345
4278:28350952
4237:30210428
4186:39499491
4143:29643634
4078:30111960
4027:29503555
3973:27398032
3913:25852064
3878:30765407
3848:BMJ Open
3829:25822730
3789:PLOS ONE
3770:19398386
3710:24725422
3666:23083437
3617:30020970
3577:PLOS ONE
3509:26005583
3434:49396022
3426:29935152
3390:19796387
3336:29016932
3295:25031804
3246:24455309
3189:29630280
3164:30325622
3130:29630225
3105:21508345
3056:23271922
3005:23886845
2953:19881973
2899:30646197
2823:26354988
2765:34821901
2757:22158059
2717:12962371
2709:24633719
2662:26424349
2615:30774933
2559:28613622
2513:28551282
2472:28413220
2420:20227646
2324:83464182
2316:30888546
2258:21156951
2154:26727925
2048:24829876
1986:31870637
1938:16408366
1897:26435805
1835:31808530
1711:See also
1672:antibody
1164:steroids
1058:ischemic
973:Present
895:Walking
883:Vascular
463:steroids
412:numbness
408:cramping
404:tingling
361:ischemia
271:steroids
73:Symptoms
4512:5333707
4412:5106443
4363:3745686
4228:6124480
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4178:2279841
4134:5885425
4069:6069623
4018:5825994
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3761:3775665
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3608:6051614
3585:Bibcode
3500:4431053
3381:2762954
3286:4099231
3237:3888748
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2996:3870489
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2890:6324321
2814:4607594
2606:6357993
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2411:2841052
2249:3260477
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2086:9575322
2039:4017306
1888:4591458
1826:7101166
1248:ground.
1162:and/or
962:Common
905:flexion
903:Spinal
826:viscera
673:Obesity
614:lesions
508:flexion
428:flexion
291:symptom
156:obesity
4519:
4509:
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1823:
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1398:lamina
1325:myelin
1266:relax.
1228:pelvis
1146:, and
951:Sharp
767:, and
750:pulses
646:tumors
624:, and
574:Causes
554:, and
349:glutes
174:X-Rays
139:trauma
103:Causes
79:glutes
4476:S2CID
4282:S2CID
4182:S2CID
3917:S2CID
3714:S2CID
3554:S2CID
3430:S2CID
2761:S2CID
2737:Spine
2713:S2CID
2320:S2CID
1508:is a
1270:pair.
1244:legs.
824:, or
475:X-Ray
319:
317:Latin
154:Age,
4517:PMID
4468:PMID
4417:PMID
4368:PMID
4317:PMID
4274:PMID
4233:PMID
4174:PMID
4139:PMID
4092:link
4074:PMID
4023:PMID
3969:PMID
3909:PMID
3874:PMID
3825:PMID
3766:PMID
3706:PMID
3662:PMID
3613:PMID
3546:ISSN
3505:PMID
3422:PMID
3386:PMID
3332:PMID
3291:PMID
3242:PMID
3218:2013
3185:PMID
3160:PMID
3126:PMID
3101:PMID
3052:PMID
3001:PMID
2949:PMID
2895:PMID
2819:PMID
2753:PMID
2705:PMID
2658:PMID
2650:ISSN
2611:PMID
2555:PMID
2509:PMID
2468:PMID
2416:PMID
2360:ISBN
2312:PMID
2254:PMID
2228:JAMA
2188:ISBN
2150:PMID
2082:PMID
2044:PMID
1982:PMID
1934:PMID
1893:PMID
1831:PMID
1481:and
1465:and
1457:For
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1033:and
568:gait
461:and
453:and
269:and
172:and
81:and
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4458:hdl
4448:doi
4407:PMC
4399:doi
4358:PMC
4348:doi
4309:doi
4264:doi
4223:PMC
4213:doi
4166:doi
4129:PMC
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4054:doi
4013:PMC
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3959:PMC
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