- Spinal stenosis
Name = Spinal stenosis
ICD10 = ICD10|M|48|0|m|45
ICD9 = ICD9|723-ICD9|724
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 vertebrae, the lumbar vertebraeor both. Lumbar spinal stenosis results in low back pain as well as pain or abnormal sensations in the legs, thighs, feet or buttocks, or loss of bladder and bowel control.
Cervical spinal stenosis
The main causes of cervical spinal stenosis (CSS) include cervical spondylosis, diffuse idiopathic skeletal hyperostosis (DISH), or
calcificationof 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, lower extremity weakness or both, radicular pain in the upper limb, sphincter disturbances, muscle wasting, sensory deficits, and reflex abnormalities.
X-Ray of cervical spine+/- flexion/extension view, CT/myelogram.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, analgesics. If severe, treatments include
laminectomy, hemilaminectomy, or decompression.
Lumbar spinal stenosis
The main causes of lumbar spinal stenosis (LSS) include organ
hypertrophyof 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 (tool) 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.
patients with::"neurogenic claudication or radicular leg pain with associated neurologic signs, spinal stenosis shown on cross-sectional imaging, and degenerative spondylolisthesis shown on lateral radiographs obtained with the patient in a standing position. The patients had had persistent symptoms for at least 12 weeks and had been confirmed as surgical candidates by their physicians. Patients with adjacent levels of stenosis were eligible; patients with spondylolysis and isthmic spondylolisthesis were not."found that patients::"treated surgically showed substantially greater improvement in pain and function during a period of 2 years than patients treated nonsurgically." "Some patients may require pain management post surgically. It is important to be treated by a Board Certified Pain specialist,and take all medication as directed".
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