Spinal stenosis: Difference between revisions

Jump to navigation Jump to search
No edit summary
m (Reverted edits by M Jahan (talk) to last revision by Christopher Popma)
Tag: Rollback
 
(7 intermediate revisions by 4 users not shown)
Line 1: Line 1:
{{DiseaseDisorder infobox |
  Name        = Spinal stenosis |
  ICD10      = {{ICD10|M|48|0|m|45}} |
  ICD9        = {{ICD9|723}}-{{ICD9|724}} |
}}
{{Search infobox}}
__NOTOC__
__NOTOC__
{{Spinal stenosis}}
For patient information click [[Spinal stenosis (patient information)|here]]


{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
==[[Spinal stenosis overview|Overview]]==


==Overview==
==[[Spinal stenosis classification|Classification]]==
'''Spinal stenosis''' is a [[medicine|medical]] condition in which 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 vertebrae|cervical spine]], the [[lumbar vertebrae|lumbar spine]] or both.  Lumbar spinal stenosis results in low [[back pain]] as well as [[Pain and nociception|pain]] or abnormal sensations in the [[leg]]s.


==Cervical spinal stenosis==
==[[Spinal stenosis pathophysiology|Pathophysiology]]==
The main causes of '''cervical spinal stenosis (CSS)''' include cervical [[spondylosis]], diffuse idiopathic skeletal hyperostosis (DISH), or [[calcium|calcification]] of the posterior longitudinal ligament.


CSS is more common in [[male]]s than [[female]]s, and is mainly found in the 40-60 year age group.
==[[Spinal stenosis causes|Causes]]==


[[Sign (medicine)|Sign]]s 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.
==[[Spinal stenosis differential diagnosis|Differentiating Spinal stenosis from other Diseases]]==


===Diagnosis===
==[[Spinal stenosis epidemiology and demographics|Epidemiology and Demographics]]==
The best diagnostic and investigative tool is [[magnetic resonance imaging]] (MRI), while computed tomograghy (CT) is somewhat useful if MRI is unavailable. However, spinal stenosis can be found in asymptomatic patients.<ref name="pmid3588931">{{cite journal |author=Teresi LM, Lufkin RB, Reicher MA, ''et al'' |title=Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging |journal=Radiology |volume=164 |issue=1 |pages=83-8 |year=1987 |pmid=3588931 |doi=}}</ref><ref name="pmid2398088">{{cite journal |author=Boden SD, McCowin PR, Davis DO, Dina TS, Mark AS, Wiesel S |title=Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation |journal=The Journal of bone and joint surgery. American volume |volume=72 |issue=8 |pages=1178-84 |year=1990 |pmid=2398088 |doi=}}</ref><ref name="pmid16129249">{{cite journal |author=Ernst CW, Stadnik TW, Peeters E, Breucq C, Osteaux MJ |title=Prevalence of annular tears and disc herniations on MR images of the cervical spine in symptom free volunteers |journal=European journal of radiology |volume=55 |issue=3 |pages=409-14 |year=2005 |pmid=16129249 |doi=10.1016/j.ejrad.2004.11.003}}</ref>


===Treatment===
==[[Spinal stenosis risk factors|Risk Factors]]==
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]], [[hemilaminectomy]], or decompression.


==Lumbar spinal stenosis==
==[[Spinal stenosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
The main causes of '''lumbar spinal stenosis (LSS)''' include [[Organ hypertrophy|hypertrophy]] of the facet joints or [[osteoarthritis]]; [[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.
==Diagnosis==
[[Spinal stenosis history and symptoms|History and Symptoms]] | [[Spinal stenosis physical examination|Physical Examination]] | [[Spinal stenosis x ray|X Ray]] | [[Spinal stenosis CT|CT]] | [[Spinal stenosis MRI|MRI]] | [[Spinal stenosis other diagnostic studies|Other Diagnostic Studies]]


Signs of LSS include neurogenic intermittent [[claudication]] that causes leg pain, weakness, tingling and loss of deep tendon reflexes. Many of these leg symptoms are referred to as [[sciatica]]. Low back pain may or may not be present. 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, such as walking while leaning on a shopping cart. On the other hand, pain is worse with extension of the back at the hips, which is why patients prefer to lean forward or to sit down, as these actions flex the body at the hip.  This is also why patient complain of increased pain walking downhill as opposed to uphill.
==Treatment==
[[Spinal stenosis medical therapy|Medical Therapy]] | [[Spinal stenosis surgery|Surgery]] | [[Spinal stenosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Spinal stenosis future or investigational therapies|Future or Investigational Therapies]]


===Diagnosis===
==Case Studies==
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.
:[[Spinal stenosis case study one|Case #1]]
 
===Treatment===
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 to take pressure off the spinal nerve.
 
====Surgical laminectomy====
Regarding indications for [[laminectomy]], a complicated, nonrandomized analysis of a [[randomized controlled trial]] of [[laminectomy]]<ref name="pmid17538085">{{cite journal |author=Weinstein JN, Lurie JD, Tosteson TD, ''et al'' |title=Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis |journal=N. Engl. J. Med. |volume=356 |issue=22 |pages=2257-70 |year=2007 |pmid=17538085 |doi=10.1056/NEJMoa070302}}</ref>, in patients with:
:"neurogenic claudication or radicular leg pain with associated neurologic signs, spinal stenosis shown on cross-sectional imaging, and degenerative spondylolisthesis shown on lateral radiographs obtained with the patient in a standing position. The patients had had persistent symptoms for at least 12 weeks and had been confirmed as surgical candidates by their physicians. Patients with adjacent levels of stenosis were eligible; patients with spondylolysis and isthmic spondylolisthesis were not."
found that patients:
:"treated surgically showed substantially greater improvement in pain and function during a period of 2 years than patients treated nonsurgically."
 
====New surgical developments====
 
Recent developments include several new implants used in surgery to treat the symptoms of spinal stenosis, while preserving as much normal motion in the spine as possible.  The only FDA approved non-fusion treatment is the X STOP, [http://www.sfmt.com/  by St. Francis Medical Techologies, Inc.] which works via indirect decompression, called Interspinous Process Decompression [http://en.wikipedia.org/wiki/Interspinous_Process_Decompression](IPD) Some other IPD technologies that are still being studied include the Wallis implant, [http://us.abbottspine.com/index.php?pid=44 by Aboott Spine] , the DIAM [http://www.medtronic.com/ by Medtronic] and the Coflex by [http://www.paradigm-spine.de/web/wirbelkanal.php Paradigm Spine], .<ref name="Stromquist"> {{cite web| author=B. Stromqvist|year=2006 |title= Lumbar Spinal Stenosis - Striving for Less Invasive  Surgery|url=http://www.touchneurology.com/articles.cfm?article_id=5604&level=2}}</ref> Other implant systems being studied include the Dynesys [http://www.zimmer.com/z/ctl/op/global/action/1/id/9163/template/PC/prcat/P6/prod/y by Zimmer], the Stabilimax [http://www.appliedspine.com/ by Applied Spine], the TFAS [http://www.archusorthopedics.com/ by Archus Orthopedics] and the Anatomic Facet Replacement System, [http://www.stenosisrelief.com/pages/aboutafrs.htm by Facet Solutions]
 
In November 2005 the X-STOP was approved by the [[FDA]] for treatment of lumbar spinal stenosis with moderate symptoms. This procedure is a much less invasive surgery than decompression, but the treatment is still new and effectiveness, indications and potential risks and complications won't be well understood until the procedure has been in use for a longer period.
 
One recent implant system that was being studied in the US reportedly has problems that ended its enrollment, the TOPS implant [http://www.impliant.com by Impliant.] This was reported [http://www.marketwatch.com/news/story/impliant-deepens-elron-loss/story.aspx?guid=%7BD0A6748D-9F78-4155-90D2-13BD50783D0C%7D ]by an investor in Impliant, [http://www.elron.com/default.asp?PageId=0 Elron Ltd.]
 
Also recently, [http://209.85.173.104/search?q=cache:g71FsSBs9joJ:www.sofamordanek.com/spineline/physician/agileguide.pdf+CD+Agile+spine&hl=en&ct=clnk&cd=1&gl=us&client=firefox-a Medtronic's] non-fusion implant was recalled officially in the United Kingdom [http://209.85.173.104/search?q=cache:mNI1si-aw6QJ:www.mhra.gov.uk/home/idcplg%3FIdcService%3DGET_FILE%26dDocName%3DCON2033507%26RevisionSelectionMethod%3DLatestReleased+Medtronic+Agile+recall&hl=en&ct=clnk&cd=1&gl=us&client=firefox-a], though in the US the device has been withdrawn from surgeons but MDT has not issued a recall, probably due to the way inventory is handled rather than a difference in the product sold in the US vs. the UK.
 
== External links ==
 
* [http://www.ascent-oxford.kramesonline.com/HealthSheets/3,S,84755 Spinal Stenosis - Information for Patients]
* [http://www.spine-health.com/stenosis/ Spinal Stenosis for Patient information]
* [http://www.spineuniverse.com/displayarticle.php/article244.html Lumbar Spinal Stenosis]
* [http://www.spineuniverse.com/displayarticle.php/article334.html Cervical Disorders - Spinal Stenosis and Disc Herniation]
 
==References==
<div class="references-small" style="-moz-column-count:2; column-count:2;">
<references/>
</div>


{{Diseases of the musculoskeletal system and connective tissue}}
{{Diseases of the musculoskeletal system and connective tissue}}
{{SIB}}


[[Category:Skeletal disorders]]
[[Category:Skeletal disorders]]

Latest revision as of 05:20, 6 May 2020

Spinal stenosis Microchapters

Home

Patient Information

Overview

Classification

Pathophysiology

Causes

Differentiating spinal stenosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Spinal stenosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Spinal stenosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Spinal stenosis

CDC on Spinal stenosis

Spinal stenosis in the news

Blogs on Spinal stenosis

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Spinal stenosis

For patient information click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Classification

Pathophysiology

Causes

Differentiating Spinal stenosis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | X Ray | CT | MRI | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Template:Diseases of the musculoskeletal system and connective tissue

nl:Wervelkanaalstenose


Template:WikiDoc Sources