spinal stenosis

see also:

• neurology
• neurosurgery
• oncology
• acute spinal cord compression
• cauda equina syndrome (CES)
• lumbar facet joint degenerative arthropathy
• spinal cord syndromes and lesions
• sensory & motor testing including dermatomes, myotomes, reflexes, coordination & balance

• spinal stenosis is narrowing of the spinal canal or neural foraminae resulting in pressure on the spinal cord or nerve roots
• “central stenosis” is used if the whole central spinal canal is compressed, and “foraminal or lateral stenosis” if the single nerve root exiting the neural foramina is compressed
• lumbar stenosis is most common followed by cervical stenosis
• 1st described by Antoine Portal in 1803

• usually degenerative as a result of lumbar facet joint degenerative arthropathy 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
  • affects some 8% of the elderly population
• congenital forms may present between ages 30 and 50 yrs
  • congenitally small central canal
• genetic factors
  • heritability of LSS appears to be 0.67
  • over 88 genetic regions are associated¹⁾
  • 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 rheumatoid arthritis, ankylosing spondylitis (AS), spinal tumours, trauma, Paget's disease, scoliosis, spondylolisthesis, achondroplasia
• whole body fat-free mass and higher LSS risk (OR = 1.724)²⁾
• body mass index (BMI) and higher LSS risk (OR = 1.553)³⁾

• 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

• low back pain can be present or absent
• 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
• sciatica may occur and may be bilateral
• severe cases may cause cauda equina syndrome (CES)

• MRI or CT scan

• analgesia
• activity modification
• physiotherapy
• surgical Rx may be needed if:
  • symptoms do not improve and are a significant issue
  • cauda equina syndrome (CES) develops

• can be more dangerous than lumbar stenosis as it may cause acute spinal cord compression and resulting myelopathy