Lumbar spinal stenosis

Lumbar spinal stenosis
Specialty	Rheumatology

Spinal stenosis is a medical condition where 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.

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 in reflexes.

The best diagnostic and investigative tool is magnetic resonance imaging (MRI), while computed tomograghy (CT) is not useful.

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 or decompression.

Lumbar spinal stenosis

The main causes of lumbar spinal stenosis (LSS) include hypertrophy of the facet joints; 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, and loss of deep tendon reflexes. 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 or walking with a shopping cart.

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. A new procedure, Interspinous Process Decompression (IPD) has recently been approved by the FDA in November of 2005. This procedure promises a less invasive way to treat LSS and maintains motion at the affected level.

Recent developments include the X-Stop and the Walis implant - designed for extra-canalicular treatment of spinal stenosis . Titanium implants act to prevent extension of the stenotic segments and create slight flexion over the segment.

External links

• Referencio - Cervical Spinal Stenosis (for health professionals) Wiki directory
• Lumbar Spinal Stenosis
• Cervical Disorders - Spinal Stenosis and Disc Herniation