Spinal stenosis
Cards (11)
- Spinal stenosis:
- Narrowing of part of the spinal canal resulting in compression of the spinal cord (myelopathy) or nerve root (radiculopathy)
- Usually affects cervical or lumbar spine - lumbar is most common
- Central spinal canal = central stenosis
- Nerve root canal = lateral stenosis
- Intervertebral foramina = foramina stenosis
- Bony causes:
- Spondylosis (spine OA)
- Spondylolisthesis
- Fractures
- Malignancy
- Paget's
- Congenital abnormality
- Disc causes:
- Bulging
- Herniation
- Ligament causes:
- Ligamentum flavum hypertrophy - degenerative changes to spine leads to thickening
- Ossification of posterior longitudinal ligament - unclear why this happens
- Soft tissue causes:
- Cysts
- Abscess
- Tumours
- Presentation:
- Most common cause is spondylosis of the lumbar spine
- Usually a person >60 yrs with a gradual onset of symptoms
- Severity of symptoms depends on degree of narrowing and what is being compressed
- When compression is severe this can cause spinal cord compression/cauda equina syndrome (depending on location) and requires emergency management
- Key presenting symptoms:
- Intermittent neurogenic claudication - lower back pain, buttock and leg pain/paraesthesia, leg weakness
- Shopping cart sign - symptoms come on when standing/walking and are relieved by bending forward or sitting down (expand the spinal canal) - typically suggests central and/or lateral stenosis
- A key differential diagnosis is claudication from PAD, key things that point to neurogenic claudication =
- Back pain
- Positional nature of pain
- Normal peripheral arterial examination e.g. normal pulses and ABPI
- If there is lateral and foramina stenosis in the lumbar spine this can also cause lumbosacral radiculopathy symptoms - sciatica
- Investigations:
- MRI
- May consider ABPI and/or angiogram to rule out PAD
- Management:
- Exercise and weight loss
- Analgesia - paracetamol and ibuprofen
- Physiotherapy
- Decompression surgery where conservative treatment fails - laminectomy