Question

which case history is consistent with cooks clinical prediction rule for lumbar spinal stenosis (lss)?
45-year-old with unilateral leg pain, worse with sitting, relieved by walking
60-year-old with bilateral leg pain, worse with walking, relieved by sitting
55-year-old with unilateral leg pain and numbness, worse with standing
50-year-old with back pain greater than leg pain, no relief with sitting

Explanation:

Cook's Clinical Prediction Rule for Lumbar Spinal Stenosis (LSS) is associated with typical clinical features: patients are often older (usually over 50), present with bilateral leg pain (neurogenic claudication) that worsens with walking or standing (due to increased spinal canal pressure) and is relieved by sitting or flexing the spine (which opens the spinal canal). We match these features to the options:

1. The first option has pain worse with sitting, which is opposite of LSS.
2. The second option matches: older age, bilateral leg pain, worse with walking, relieved by sitting.
3. The third option has unilateral pain, which is less typical for LSS.
4. The fourth option has back pain greater than leg pain, which is not consistent with LSS's primary symptom of leg pain from neurogenic claudication.

Answer:

60-year-old with bilateral leg pain, worse with walking, relieved by sitting