Spinal stenosis

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Spinal stenosis
Classification and external resources
LUMBAR TREFOIL CANAL.JPG
Lumbar trefoil canal
MedlinePlus000441
 
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Spinal stenosis
Classification and external resources
LUMBAR TREFOIL CANAL.JPG
Lumbar trefoil canal
MedlinePlus000441

Spinal stenosis is an abnormal narrowing (stenosis) of the spinal canal that may occur in any of the regions of the spine. This narrowing causes a restriction to the spinal canal, resulting in a neurological deficit. Symptoms include pain, numbness, paraesthesia, and loss of motor control. The location of the stenosis determines which area of the body is affected.[1] With spinal stenosis, the spinal canal is narrowed at the vertebral canal, which is a foramen between the vertebrae where the spinal cord (in the cervical or thoracic spine) or nerve roots (in the lumbar spine) pass through.[2] There are several types of spinal stenosis, with lumbar stenosis and cervical stenosis being the most frequent. While lumbar spinal stenosis is more common, cervical spinal stenosis is more dangerous because it involves compression of the spinal cord whereas the lumbar spinal stenosis involves compression of the cauda equina.

Types[edit]

The most common forms are cervical spinal stenosis, at the level of the neck, and lumbar spinal stenosis, at the level of the lower back. Thoracic spinal stenosis, at the level of the mid-back, is much less common.[1]

In lumbar stenosis, the spinal nerve roots in the lower back are compressed which can lead to symptoms of sciatica (tingling, weakness, or numbness that radiates from the low back and into the buttocks and legs).

Cervical spinal stenosis can be far more dangerous by compressing the spinal cord. Cervical canal stenosis may lead to serious symptoms such as major body weakness and paralysis. Such severe spinal stenosis symptoms are virtually absent in lumbar stenosis, however, as the spinal cord terminates at the top end of the adult lumbar spine, with only nerve roots (cauda equina) continuing further down.[3] Cervical spinal stenosis is a condition involving narrowing of the spinal canal at the level of the neck. It is frequently due to chronic degeneration,[4] but may also be congenital or traumatic. Treatment frequently is surgical.[4]

Signs and symptoms[edit]

Illustration depicting spinal stenosis and spinal cord compression

Common[edit]

Neurological disorders[edit]

Other[edit]

Causes[edit]

Aging: All the factors below may cause the spaces in the spine to narrow,

Arthritis: Two types,

Heredity:

Instability of the spine, or spondylolisthesis:

Trauma:

Tumors of the spine:

Diagnosis[edit]

Making the diagnosis of spinal stenosis involves a complete evaluation of the spine. The process always begins with a medical history and physical

MRI exhibiting areas of lumbar stenosis

examination. Imaging studies (x-ray, MRI, etc.) are often used to determine the extent and location of the nerve compression.

Medical history[edit]

The medical history is the most important aspect of the examination as it will tell the physician about subjective symptoms, possible causes for spinal stenosis, and other possible causes of back pain.[12]

Physical examination[edit]

The physical examination of a patient with spinal stenosis will give the physician information about exactly where nerve compression is occurring. Some important factors that should be investigated are any areas of sensory abnormalities, numbness, irregular reflexes, and any muscular weakness. [12]

MRI[edit]

The MRI has become the most frequently used study to diagnose spinal stenosis. The MRI uses magnetic signals (instead of x-rays) to produce images of the spine. MRIs are helpful because they show more structures, including nerves, muscles, and ligaments, than seen on x-rays or CT scans. MRIs are helpful at showing exactly what is causing spinal nerve compression.[12]

CT myelogram[edit]

A spinal tap is performed in the low back with dye injected into the spinal fluid. X-Rays are performed followed by a CT scan of the spine to help see narrowing of the spinal canal. This is a very effective study in cases of lateral recess stenosis. It is also necessary in patients with a pacemaker as they cannot undergo an MRI.

Treatments[edit]

Non-surgical treatment[edit]

Surgical Treatment[edit]

Epidemiology[edit]

References[edit]

  1. ^ a b Vokshoor A (February 14, 2010). "Spinal Stenosis". eMedicine. Retrieved December 30, 2010. 
  2. ^ http://www.niams.nih.gov/Health_Info/Spinal_Stenosis/spinal_stenosis_ff.asp
  3. ^ Waxman, SG (2000). Correlative Neuroanatomy (24th ed.). 
  4. ^ a b Meyer F, Börm W, Thomé C (May 2008). "Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment". Dtsch Arztebl Int 105 (20): 366–72. doi:10.3238/arztebl.2008.0366. PMC 2696878. PMID 19626174. 
  5. ^ a b c d e Mazanec, D.J., Podichetty, V.K., Hsia, A. (2002) Lumbar Canal Stenosis: Start with nonsurgical therapy. Cleveland Clinic Journal of Medicine 69(11).
  6. ^ "Cervical Radiculopathy (Pinched Nerve)". AAOS. Retrieved 13 December 2011. 
  7. ^ a b c Costantini, A., Buchser, E., Van Buyten, J.P. (2009). Spinal Cord Stimulation for the Treatment of Chronic Pain in Patients with Lumbar Spinal Stenosis. Neuromodulation, 13(4), 275-380. doi:10.1111/j.1525-1403.2010.00289.x
  8. ^ a b c Goren, A., Yildiz, N., Topuz, O., Findikoglu, G., & Ardic, F. (2010). Efficacy of exercise and ultrasound in patients with lumbar spinal stenosis: A prospective randomized controlled trial. Clinical Rehabilitation, 24(7), 623-631. doi:10.1177/0269215510367539
  9. ^ a b Doorly, T.P., Lambing, C.L., Malanga, G.A., Maurer, P.M., Ralph R., R. (2010). Algorithmic approach to the management of the patient with lumbar spinal stenosis. Journal of Family Practice, 59 S1-S8
  10. ^ Mazanec, D.J., Podichetty, V.K., Hsia, A. (2002) LumbarClinic Journal of Medicine 69(11).
  11. ^ http://www.mayoclinic.com/health/spinal-stenosis/DS00515/DSECTION=causes
  12. ^ a b c Cluett, Jonathan, M.D. (2010) How is spinal stenosis diagnosed, spinal stenosis, http://orthopedics.about.com/cs/spinalstenosis/a/spinalstenosis_2.htm
  13. ^ http://www.webmd.com/back-pain/tc/lumbar-spinal-stenosis-treatment-overview
  14. ^ Friedly, Janna L.; Comstock, Bryan A.; Turner, Judith A.; Heagerty, Patrick J.; Deyo, Richard A.; Sullivan, Sean D.; Bauer, Zoya; Bresnahan, Brian W.; Avins, Andrew L.; Nedeljkovic, Srdjan S.; Nerenz, David R.; Standaert, Christopher; Kessler, Larry; Akuthota, Venu; Annaswamy, Thiru; Chen, Allen; Diehn, Felix; Firtch, William; Gerges, Frederic J.; Gilligan, Christopher; Goldberg, Harley; Kennedy, David J.; Mandel, Shlomo; Tyburski, Mark; Sanders, William; Sibell, David; Smuck, Matthew; Wasan, Ajay; Won, Lawrence; Jarvik, Jeffrey G. (3 July 2014). "A Randomized Trial of Epidural Glucocorticoid Injections for Spinal Stenosis". New England Journal of Medicine 371 (1): 11–21. doi:10.1056/NEJMoa1313265. 
  15. ^ Malamut, edited by Joseph I. Sirven, Barbara L. (2008). Clinical neurology of the older adult (2nd ed. ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 220. ISBN 9780781769471. 
  16. ^ http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm327502.htm
  17. ^ http://www.vancouverspinecarecentre.com/con_spinalstenosis
  18. ^ Spinal Stenosis. (2011) In SpinalStenosis.org. Retrieved 2/29/12, from http://www.spinalstenosis.org/.
  19. ^ Treatment of Degenerative Lumbar Spinal Stenosis: Summary of Evidence Report/Technology Assessment, No. 32. (2001). In AHRQ Archive--Home Page. Retrieved 2/29/2012, fromhttp://archive.ahrq.gov/clinic/epcsums/stenosum.htm.

External links[edit]