Spinal stenosis classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Classification
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.
Diagnosis
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.[1][2][3]
Treatment
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
The main causes of lumbar spinal stenosis (LSS) include 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.
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.
Diagnosis
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
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.
References
- ↑ Teresi LM, Lufkin RB, Reicher MA; et al. (1987). "Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging". Radiology. 164 (1): 83–8. PMID 3588931.
- ↑ Boden SD, McCowin PR, Davis DO, Dina TS, Mark AS, Wiesel S (1990). "Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation". The Journal of bone and joint surgery. American volume. 72 (8): 1178–84. PMID 2398088.
- ↑ Ernst CW, Stadnik TW, Peeters E, Breucq C, Osteaux MJ (2005). "Prevalence of annular tears and disc herniations on MR images of the cervical spine in symptom free volunteers". European journal of radiology. 55 (3): 409–14. doi:10.1016/j.ejrad.2004.11.003. PMID 16129249.