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Spinal stenosis is a medical condition in which the spinal canal narrows and compresses the spinal cord and nerves. This is usually due to the natural process of spinal degeneration that occurs with aging. It can also sometimes be caused by spinal disc herniation, osteoporosis, or a tumour. Spinal stenosis may affect the cervical spine, the lumbar spine or both. Lumbar spinal stenosis results in low back pain as well as pain or abnormal sensations in the legs.
Additional recommended knowledge
Cervical spinal stenosis
The main causes of cervical spinal stenosis (CSS) include cervical spondylosis, diffuse idiopathic skeletal hyperostosis (DISH), or calcification of the posterior longitudinal ligament.
CSS is more common in males than females, and is mainly found in the 40-60 year age group.
Signs of CSS include spastic gait; upper extremity numbness; upper extremity, lower extremity weakness or both; radicular pain in the upper limb; sphincter disturbances; muscle wasting; sensory deficits; and reflex abnormalities.
The best diagnostic and investigative tool is magnetic resonance imaging (MRI), while computed tomograghy (CT) is somewhat useful if MRI is unavailable. However, spinal stenosis can be found in asymptomatic patients.
If the problem is mild, treatment may be as simple as physical therapy and the use of a cervical collar. If severe, treatments include laminectomy, hemilaminectomy, or decompression.
Lumbar spinal stenosis
The main causes of lumbar spinal stenosis (LSS) include hypertrophy of the facet joints or osteoarthritis; spondylolisthesis; diffuse idiopathic skeletal hyperostosis (DISH); and degenerative disc disease.
Usually, this condition occurs after the age of 50, and both genders are equally affected.
Signs of LSS include neurogenic intermittent claudication that causes leg pain, weakness, tingling and loss of deep tendon reflexes. Many of these leg symptoms are referred to as sciatica. Low back pain may or may not be present. With lumbar spinal stenosis, the patient's pain usually is worse while walking and will feel better after sitting down. The patient is usually more comfortable while leaning forward, such as walking while leaning on a shopping cart. On the other hand, pain is worse with extension of the back at the hips, which is why patients prefer to lean forward or to sit down, as these actions flex the body at the hip. This is also why patients complain of increased pain walking downhill as opposed to uphill.
As with CSS, MRI is the best imaging procedure, though unlike with CSS, CT may be somewhat useful, and can be used if MRI is unavailable.
Treatment includes weight loss, and activity modification, such as using a walker to promote a certain posture. Epidural steroid injections may also help relieve the leg pain.
If the symptoms are more severe, a laminectomy or foraminotomy may be indicated to take pressure off the spinal nerve.
Regarding indications for laminectomy, a complicated, nonrandomized analysis of a randomized controlled trial of laminectomy, in patients with:
found that patients:
New surgical developments
Recent developments include several new implants used in surgery to treat the symptoms of spinal stenosis, while preserving as much normal motion in the spine as possible. Three newer technologies include the X-Stop, the Wallis, and TOPS implants. These mostly titanium implants (the Wallis Ligament is predominantly constructed out of PEEK) act to prevent extension of the stenotic segments and create slight flexion over the segment.
In November 2005 the X-STOP was approved by the FDA for treatment of lumbar spinal stenosis with moderate symptoms. This procedure is a much less invasive surgery than decompression, but the treatment is still new and effectiveness, indications and potential risks and complications won't be well understood until the procedure has been in use for a longer period.
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Spinal_stenosis". A list of authors is available in Wikipedia.|