Night pain associated with diminished cardiopulmonary compliance. A concomitant of lumbar spinal stenosis and degenerative spondylolisthesis.

Twenty patients admitted to hospital with congestive heart failure were evaluated for severe concomitant lumbosacral and leg pain. In each instance the discomfort was worse at night and progressively decreased with a resolution of the pulmonary edema. Neurologic and electromyographic examinations in all but four patients were normal with reflexes, strength and straight leg raising testing normal. An absent Achilles reflex was recognized in two, a diminished knee jerk reflex in one and in a third, weakness in the extensor hallucis longus. Lumbar spinal stenosis was identified in all of the patients with a concomitant degenerative spondylolisthesis present in nine instances and in an additional two a spondylolisthesis with interruption of the neural arch. It is theorized that diminished right heart compliance can induce a sufficient increase in venous volume and pressure within the paravertebral plexus of Batson to acutely exacerbate a chronic lumbar spinal stenosis. In support of this hypothesis, the multiple factors involved in the pathomechanics and physiology of lumbar radiculopathy, spinal stenosis and the role of the paravertebral plexus of veins are examined. Specifically, their response to altered volume and pressure gradients tending to induce venous "creep" as well to alterations in posture and diurnal cycles are reviewed.