TAGMED Clinic Montreal / Mount Royal
Lumbar stenosis and leg numbness: what the distribution may suggest
Interpréter un engourdissement qui apparaît à la marche ou en station debout dans un contexte de sténose.
L’engourdissement peut être focal, radiculaire ou plus diffus. Lorsqu’il apparaît surtout après une période de marche et s’améliore en s’asseyant, une composante de claudication neurogène peut être envisagée, mais d’autres causes doivent être exclues.
- Related page in this guide series Sciatica treatment in Montreal.
- La sténose visible à l’imagerie doit être corrélée aux symptômes et à la fonction.
- Une faiblesse progressive ou des signes de compression neurologique sévère modifient le degré d’urgence.
Understanding
Pourquoi la sténose ne se résume pas à un chiffre d’IRM
L’engourdissement peut être focal, radiculaire ou plus diffus. Lorsqu’il apparaît surtout après une période de marche et s’améliore en s’asseyant, une composante de claudication neurogène peut être envisagée, mais d’autres causes doivent être exclues.
Symptoms
Douleur, lourdeur, engourdissement ou faiblesse sont décrits selon leur trajet, leur côté et leur déclenchement.
Function
La distance de marche, la station debout et les positions de soulagement permettent de mesurer le retentissement réel.
Concordance
L’imagerie est plus utile lorsqu’elle correspond au niveau, au côté et au comportement des symptômes.
Clinical interpretation
La forme et le déclenchement de l’engourdissement comptent
Un territoire bien défini dans un pied ne s’interprète pas comme un engourdissement diffus des deux jambes. Le moment d’apparition, le côté, la progression et la présence de faiblesse orientent l’évaluation.
Key takeaways
La sévérité radiologique et la sévérité clinique ne sont pas toujours identiques. La décision de traitement dépend surtout de la concordance, de la fonction et de l’évolution neurologique.
Assessment
Différencier radiculopathie, neuropathie et autres causes
La sensibilité est comparée aux territoires neurologiques plausibles et aux autres éléments de l’examen. Un diabète, une neuropathie périphérique ou un problème vasculaire peuvent parfois produire des symptômes différents mais voisins.
1
Describe
Préciser douleur, engourdissement, faiblesse, durée et facteurs aggravants.
2
Mesurer
Quantifier marche, station debout, temps de récupération et activités limitées.
3
Examine
Comparer force, sensibilité, réflexes et fonction entre les deux côtés.
4
Correlate
Relier l’examen à l’imagerie lorsque celle-ci peut modifier la prise en charge.
Support
Les options dépendent surtout de la fonction et des déficits neurologiques
La prise en charge peut inclure maintien d’activités tolérées, exercice ou réadaptation adaptés et autres mesures conservatrices. Les recommandations NICE ne préconisent pas la traction de routine pour la lombalgie avec ou sans sciatique; toute modalité de traction ou de décompression doit donc être présentée comme une option clinique sélectionnée, avec limites et réévaluation, et non comme une solution universelle.
Curator
Activité adaptée, exercices et stratégies visant à préserver ou augmenter la capacité fonctionnelle.
Investigation / procédures
Imagerie, infiltration ou avis spécialisé peuvent être discutés selon les symptômes, la durée et les objectifs.
Avis chirurgical
Peut devenir pertinent en cas de déficit progressif, de limitation importante persistante ou de compression sévère concordante.
When should you seek prompt or emergency care?
- New, significant or rapidly progressive weakness.
- Recent foot drop or a leg that gives way increasingly often.
- New bladder or bowel problems.
- Numbness in the saddle area or perineum.
- Diminution rapide de la marche, symptômes bilatéraux importants, fièvre ou détérioration générale.
These signs should not wait for a routine appointment.
Follow-up
La capacité de marcher reste un indicateur majeur
Le suivi compare la distance ou la durée de marche, le besoin de s’asseoir, l’évolution de la force et de la sensibilité et la reprise des activités importantes.
Walking:
Mesurer durée et distance avant l’apparition des symptômes.
Neurology
Surveiller faiblesse, sensibilité et changements de la démarche.
Recovery
Noter le temps nécessaire pour récupérer après la marche ou la station debout.
Vous souhaitez faire évaluer vos symptômes de sténose et de sciatique?
Une consultation peut aider à relier les symptômes, l’examen, la capacité de marche et les examens déjà disponibles afin de déterminer les prochaines étapes appropriées.
Spinal decompression in Montreal · Spinal decompression in Terrebonne
Frequently Asked Questions
FAQ — Sténose lombaire et engourdissement des jambes : ce que la distribution peut suggérer
L’engourdissement signifie-t-il que le nerf est gravement endommagé?
Pas nécessairement. Sa signification dépend de la durée, de la distribution, de la progression et de la force.
Pourquoi apparaît-il surtout en marchant?
La marche peut accentuer certains symptômes de sténose ou de claudication neurogène.
Une neuropathie peut-elle ressembler à une sténose?
Oui. La distribution et les circonstances aident à les différencier.
L’engourdissement peut-il être bilatéral?
Oui, mais une atteinte bilatérale nécessite une analyse attentive.
L’IRM suffit-elle à expliquer la sensibilité?
Non. Les résultats doivent correspondre au tableau clinique.
When should you seek prompt care?
Si l’engourdissement s’étend rapidement ou s’accompagne de faiblesse.
Which signs require emergency care?
Anesthésie de la selle, troubles sphinctériens ou déficit moteur majeur progressif.
Medical references
References and guidelines
Ces références servent de repères généraux pour la sténose lombaire, la sciatique et l’imagerie. Elles ne remplacent pas une décision clinique individualisée.
- North American Spine Society — Diagnosis and Treatment of Degenerative Lumbar Spinal Stenosis
- NICE NG59 — Low back pain and sciatica: assessment and management
- American College of Radiology — Appropriateness Criteria: Low Back Pain
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Vanti, Carla, Luca Turone, Alice Panizzolo, Andrew A. Guccione, Lucia Bertozzi, and Paolo Pillastrini. 2021. “Vertical Traction for Lumbar Radiculopathy: A Systematic Review.” Archives of Physiotherapy 11(1): 7. http://doi.org/10.1186/s40945-021-00102-5.
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Close, Lint. “Current Therapeutic Options for Chronic Low Back Pain: A Focus on Nonsurgical Approaches.” http://amtradetechnology.com/publications/Online%20CME%20Albert%20Einstein%20Univ%20(6)%20(2).pdf (December 16, 2024).
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Upadhyay, S., S. Bhargava, and P. Porwal P. Porwal P. Porwal. “BACK PAIN: AN OVERVIEW BACK PAIN: AN OVERVIEW.” https://arastirmax.com/tr/system/files/dergiler/160852/makaleler/4/4/arastirmax-back-pain-overview.pdf (December 16, 2024).
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Pergolizzi Jr, Joseph V., and Darren FX Clair. 2008. “2 Prospective Evaluation of the Efficacy of Spinal Decompression via the DRX9000 for Chronic Low Back Pain.” Journal of Pain Practice: 2–8. https://www.discrepaircenter.com/Prospective%20Evaluation%20of%20the%20Efficacy%20of%20Spinal%20Decompression.pdf (December 16, 2024).
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Jimenez, Alex. “Healing Nutrients and Non-Surgical Decompression.” https://personalinjurydoctorgroup.com/2022/05/02/healing-nutrients-decompression/ (December 16, 2024).
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RELIEF, SIMPLE PELVIC TRACTION GIVES INCONSISTENT, TO HERNIATED LUMBAR, DISC SUFFERERS, and EDWARD L. EYERMAN. 1998. “Spinal Decompression Therapy Research.” Journal of Neuroimaging. https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=d20b26eb21c000ed3181c1beccc90689604aa5b3 (December 16, 2024).
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Pain, What Is Axial. “Conservative Treatment For Axial Spinal Decompression.” https://sciatica.clinic/conservative-treatment-axial-spinal-decompression/amp/ (December 16, 2024).
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Jimenez, Alex. “Lumbar Traction Decompression Therapy For Low Back Pain.” https://personalinjurydoctorgroup.com/2022/04/22/lumbar-traction-decompression-therapy-low-back-pain/ (December 16, 2024).
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Martin, Craig W. 2012. “Vertebral Axial Decompression for Low Back Pain.” https://policycommons.net/artifacts/1199478/vertebral-axial-decompression-for-low-back-pain/1752602/ (December 16, 2024).
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Jimenez, Alex. “Your Weight Could Affect Your Back: Try Decompression.” https://personalinjurydoctorgroup.com/2022/05/12/weight-could-affect-back-decompression/ (December 16, 2024).
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Adar, Sevda, Onurhan Apaydın, Umit Dündar, Hasan Toktas, Hilal Yesil, Selma Eroglu, and Nuran Eyvaz. 2024. “Comparison of the Effectiveness of Traditional Motorized Traction and Non-Surgical Spinal Decompression Therapy Added to Conventional Physiotherapy for Treatment of Chronic Low Back Pain.” Cureus 16(9): e69610. https://pmc.ncbi.nlm.nih.gov/articles/PMC11420602/ (December 16, 2024).
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Naguib, Peter Ramzy, Mohsen Mohammed Elsayaad, Hassan Hussein Mohamed, and Yasser Ramzy Lasheen. “Efficacy of Side Lying Traction versus Supine Lying Traction in Treatment of Lumbar Disc Herniation: A Randomized Controlled Trial.” https://www.academia.edu/download/100590476/6639.pdf (December 16, 2024).
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Feng, Xian-xuan, Yi-ming Xu, Yun Cai, and Yue-hong Bai. 2018. “Non-Surgical Spinal Decompression System versus Conventional Traction Device for Treating Lumbar Disc Herniation through Surface Electromyography.” Chinese Journal of Tissue Engineering Research 22(7): 1032. https://www.cjter.com/EN/10.3969/j.issn.2095-4344.0113 (December 16, 2024).
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Gong, Wontae, Sangyeol Ma, and Hyolyun Ro. 2011. “Effect of Whole Body Cryotherapy with Spinal Decompression on Cervical Disc Herniation by Digital Infrared Thermal Imaging.” Journal of physical therapy science 23(1): 107–10. https://www.jstage.jst.go.jp/article/jpts/23/1/23_1_107/_article/-char/ja/ (December 16, 2024).
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Woods, Lawrence. “Can Piriformis Syndrome Cause Constipation?” https://axialchairs.com/piriformis-syndrome-cause-constipation (December 16, 2024).
Important information
This page provides general information and does not establish a diagnosis. Results and recovery times vary according to the cause, duration, neurological signs, medical history and individual response to care.
Sylvain Desforges, docteur en ostéopathie
TAGMED Clinic — Spinal decompression, specific osteopathy and assessment of low back, disc-related and sciatic pain.
Professional profile · Contact · Main guide to sciatica in Montreal
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