Lumbar Spinal Stenosis: Multidisciplinary Care Pathway for Radiology, Nursing & Physical Therapy
Abstract
Background: Lumbar spinal stenosis (LSS) is a leading cause of pain, gait limitation, and surgery in older adults. Because symptoms reflect both fixed anatomic narrowing and posture-dependent dynamics, single-modality decisions underperform.
Aim: To outline a multidisciplinary care pathway integrating radiology, nursing, and physical therapy (PT) to improve diagnostic accuracy, functional outcomes, and value.
Methods: Narrative synthesis of core domains—anatomy, etiology, epidemiology, pathophysiology, history/physical, evaluation, treatment, prognosis, complications, patient education, and team operations—emphasizing actionable links between imaging phenotypes (central, lateral recess, foraminal, extraforaminal) and bedside/rehabilitation decisions.
Results: Flexion widens canal/foramina; extension worsens crowding—an insight that aligns patient education and PT toward flexion-biased programs. MRI remains first-line; axial-loading MRI and CT/myelography resolve discrepancies or contraindications. Standardized MRI grading (e.g., Schizas/Chen Jia/Lee) plus functional metrics (SPWT, ODI) enable decision-ready reports. Epidural injections provide short-term relief with modest effects on walking; medial branch radiofrequency helps facet-predominant pain. When needed, decompression—open, minimally invasive, or endoscopic—improves pain and function; fusion is reserved for instability/deformity. Interspinous spacers benefit selected extension-sensitive, one-to-two-level disease without osteoporosis/instability.
Conclusion: A pathway that matches mechanism to modality—precise radiology, nurse-led safety/education, and PT-led graded conditioning—yields faster, safer diagnosis and individualized care, limiting unnecessary procedures while preserving surgical benefit for appropriate candidates.
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References
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Copyright (c) 2025 Ghazy Hassan Mohajer, Amnah Abdu Khormi, Wael Atiah Safhi, Ali Majed Mohammed Malhan, Atheer Ibrahim Hadi Matabi, Mansor Ali Ahmad Alsbee, Mohammed Salem Almotairi, Abdulelah Hassan Alhathiq, Abdullah Ahmed Rayyani, Khaled Mohammed Ogdi, Abdulaziz Mohammed Yahya Moafa
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