American Board of Internal Medicine (ABIM) Certification Practice Exam

What symptom may indicate the need for spinal decompression surgery in patients with spinal stenosis?

1. Generalized weakness

2. Refractory symptoms to medical management

3. Periodic headaches

4. Stable back pain

The correct answer is: Refractory symptoms to medical management

Refractory symptoms to medical management are a primary indication for considering spinal decompression surgery in patients with spinal stenosis. When a patient experiences persistent symptoms that do not respond to conservative treatments such as physical therapy, medications, or injections, it suggests that the condition is significantly impairing their quality of life. Spinal stenosis, which involves the narrowing of the spinal canal leading to nerve compression, often results in symptoms like pain, numbness, and weakness that can severely limit mobility and function. In these cases, surgical intervention may be necessary to decompress the affected nerves and potentially relieve symptoms. The failure of conservative management indicates that the underlying structural issue causing the stenosis is likely not improving and may require surgical correction to prevent further complications, such as progressive nerve damage. In contrast, generalized weakness can have various causes, and while it might suggest a problem, it does not specifically indicate the need for surgery without additional context. Periodic headaches are generally unrelated to spinal stenosis unless they are specifically linked to cervical issues, and stable back pain suggests that there is no active progression of symptoms that would necessitate surgery. Hence, the presence of refractory symptoms serves as a clear and compelling justification for pursuing more invasive treatment options.