www.medilaw.tv – Uses superior and sagittal cross-section views to compare a normal and a congenitally stenosed spinal canal. Spinal stenosis refers to narrowing of the spinal canal and the nerve root exits (lateral recesses). Stenosis leading to central compression of the spinal cord can damage the cord (myelopathy). Stenosis is often exacerbated by movement. Compression of the nerve roots at the bottom of the spinal cord (cauda equina) can cause a cauda equina syndrome. Compression of the nerve root as it leaves the spinal canal through the lateral recess and then the intervertebral foramen (foraminal stenosis), can cause nerve root symptoms and damage (radiculopathy).
Primary spinal stenosis can be caused by
congenital malformations (incomplete vertebral arch closure (spinal dysraphism), segmentation failure, achondroplasia, osteopetrosis) or
developmental flaws (early vertebral arch ossification, shortened pedicles, thoracolumbar kyphosis, apical vertebral wedging, anterior vertebral beaking (Morquio syndrome), osseous exostosis).
Secondary spinal stenosis can be caused by
instability (rheumatoid arthritis, spondylolisthesis)
excessive scoliotic or lordotic curves
infection (epidural abscess, vertebral osteomyelitis-induced collapse of the vertebral body)
traumatic fracture of vertebral body
degenerative changes –
intervertebral disc herniation (bulging, protrusion, extrusion, sequestration, migration)
spondylosis of intervertebral disc margins (lipping)
enlargement of the vertebral body (Paget’s Disease, acromegaly)
thickening / ossification of posterior longitudinal ligament
hypertrophy (degeneration) of facet joints
facet joint synovial cysts
hypertrophy / buckling of ligamentum flavum
epidural fat deposition and/or
uncovertebral joint hypertrophy (degeneration) in the neck.
SHORT PEDICLE SYNDROME
Some people have a narrow spinal canal due to short pedicles, or thickened lamina, often at many levels. The lack of space limits the mobility of the spinal cord within the canal. It can also restrict the blood and oxygen supply to the spinal cord. Short pedicles increase the likelihood of symptoms from spinal canal narrowing caused by any of the above mentioned causes of secondary spinal stenosis.
Lumbar spinal stenosis does not always cause symptoms. Symptoms include
a sensation of heaviness, weakness, numbness, pins and needles (paresthesia), pain in the buttocks or legs when walking or with prolonged standing, which is relieved by bending forward, sitting or lying down.
Lumbar spinal stenosis rarely causes cauda equina syndrome without a large disc herniation.
The compression of the nerves caused by spinal stenosis can only be relieved by surgery. However the back pain may be decreased by
physical therapy — traction, strengthening exercises
epidural steroid injections,
avoiding bending, lifting, twisting and prolonged sitting.
Spinal stenosis is never fatal and clients very rarely lose the ability to walk. Therefore surgery is never essential. If the pain is uncontrollable, or the pressure on the nerves affects your nerve function, your surgeon will consider decompressing the nerves by removing some bone and ligaments to enlarge the spinal canal. If the compression of the spinal cord (myelopathy) or the nerve roots (radiculopathy) has been long-standing, the damage done to the nerves may be permanent, and decompressing may not reverse the symptoms. Before surgery, it is not possible to tell to what degree the symptoms will resolve after the surgery. operation presentations
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