spinal_stenosis
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| spinal_stenosis [2026/06/10 00:00] – [aetiology] gary1 | spinal_stenosis [2026/06/10 00:14] (current) – gary1 | ||
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| =====Introduction===== | =====Introduction===== | ||
| *spinal stenosis is narrowing of the spinal canal or neural foraminae resulting in pressure on the spinal cord or nerve roots | *spinal stenosis is narrowing of the spinal canal or neural foraminae resulting in pressure on the spinal cord or nerve roots | ||
| + | *" | ||
| *lumbar stenosis is most common followed by cervical stenosis | *lumbar stenosis is most common followed by cervical stenosis | ||
| *1st described by Antoine Portal in 1803 | *1st described by Antoine Portal in 1803 | ||
| - | =====Lumbar spinal stenosis===== | + | =====Lumbar spinal stenosis |
| - | ====aetiology==== | + | ====Aetiology==== |
| *usually degenerative as a result of arthritis of the facet joints and thus occurs mainly in those over 50yrs age and females are at higher risk | *usually degenerative as a result of arthritis of the facet joints and thus occurs mainly in those over 50yrs age and females are at higher risk | ||
| * as the disks dry out with age and lose height, more weight is taken on by the facet joints leading to arthritic changes and the neural foraminae become smaller | * as the disks dry out with age and lose height, more weight is taken on by the facet joints leading to arthritic changes and the neural foraminae become smaller | ||
| * affects some 8% of the elderly population | * affects some 8% of the elderly population | ||
| *congenital forms may present between ages 30 and 50 yrs | *congenital forms may present between ages 30 and 50 yrs | ||
| + | * congenitally small central canal | ||
| *genetic factors | *genetic factors | ||
| + | * heritability of LSS appears to be 0.67 | ||
| * over 88 genetic regions are associated(([[https:// | * over 88 genetic regions are associated(([[https:// | ||
| * at least 32 genetic regions are associated to more advanced forms of the disease requiring surgical treatment | * at least 32 genetic regions are associated to more advanced forms of the disease requiring surgical treatment | ||
| + | * most variants influence risk after midlife, but some confer susceptibility as early as age 34 | ||
| *other causes include [[RhA]], [[AS]], spinal tumours, trauma, Paget' | *other causes include [[RhA]], [[AS]], spinal tumours, trauma, Paget' | ||
| + | *whole body fat-free mass and higher LSS risk (OR = 1.724)(([[https:// | ||
| + | *body mass index (BMI) and higher LSS risk (OR = 1.553)(([[https:// | ||
| - | ====clinical | + | ====Epidemiology==== |
| + | *affects over 100 million people globally, with an increasing incidence due to an ageing population | ||
| + | *prevalence of diagnostic LSS is around 11%, increasing significantly with age - the majority of radiological LSS cases are asymptomatic | ||
| + | *majority of diagnoses occurring between the ages of 50 and 70 | ||
| + | |||
| + | ====Clinical | ||
| + | *low back pain can be present or absent | ||
| *pain on standing | *pain on standing | ||
| + | *symptoms are typically relieved during sitting or forward flexion | ||
| *neurogenic intermittent claudication may occur on prolonged standing, walking or extension of the lumbar spine | *neurogenic intermittent claudication may occur on prolonged standing, walking or extension of the lumbar spine | ||
| *[[sciatica]] may occur and may be bilateral | *[[sciatica]] may occur and may be bilateral | ||
| *severe cases may cause [[ces]] | *severe cases may cause [[ces]] | ||
| + | |||
| + | ====Diagnosis==== | ||
| + | *MRI or CT scan | ||
| + | |||
| + | ====Management==== | ||
| + | *analgesia | ||
| + | *activity modification | ||
| + | *physiotherapy | ||
| + | *surgical Rx may be needed if: | ||
| + | * symptoms do not improve and are a significant issue | ||
| + | * [[ces]] develops | ||
| =====Cervical spinal stenosis===== | =====Cervical spinal stenosis===== | ||
| *can be more dangerous than lumbar stenosis as it may cause [[n_spinalcordcomp]] and resulting myelopathy | *can be more dangerous than lumbar stenosis as it may cause [[n_spinalcordcomp]] and resulting myelopathy | ||
spinal_stenosis.txt · Last modified: 2026/06/10 00:14 by gary1