Lumbar spine stenosis ( LSS ) is a medical condition in which the spinal canal narrows and compresses the nerve at the level of the lumbar vertebra. This is usually due to the general occurrence of spinal degeneration that occurs with aging. Sometimes it can also be caused by spinal herniation, osteoporosis, tumors, or trauma. In the area of ​​the cervix (neck) and waist (lower back) can be a congenital condition with varying degrees.
It is also a common symptom for those suffering from various skeletal dysplasia such as with pseudoachondroplasia and achondroplasia at an early age.
Spinal stenosis can affect the cervical or thoracic area which is known as cervical spine stenosis or thoracic spine stenosis. In some cases, there may be in all three sites in the same patient. Lumbar spine stenosis can cause low back pain, abnormal sensation, and absence of sensation (numbness) in the legs, thighs, legs or buttocks, or loss of bladder and bowel control.
Video Lumbar spinal stenosis
Signs and symptoms
Understanding the meaning of signs and symptoms of lumbar stenosis requires an understanding of what the syndrome is, and the prevalence of the condition. A recent review of lumbar stenosis in the American Medical Association's "Rational Clinical Examination Series" emphasizes that this syndrome can be considered when lower limb pain occurs in combination with back pain. This syndrome occurs in 12% of men living in older communities and up to 21% of those in retirement communities.
Because limb symptoms in lumbar spinal stenosis (LSS) are similar to those found with vascular claudication, the term pseudoclaudication is often used for LSS symptoms. These symptoms include pain, weakness, and tingling of the feet, which can radiate toe to foot. Additional symptoms in the leg may be fatigue, weight, weakness, tingling sensation, puncture, or numbness and leg cramps, as well as bladder symptoms. Symptoms are most often bilateral and symmetrical, but they may be unilateral; Foot pain is usually more disturbing than back pain.
Pseudoclaudication, now commonly referred to as neurogenic claudication, usually worsens by standing or walking and improving by sitting, and is often associated with lumbar posture and extension. Lying on the side is often more comfortable than lying down, as it allows greater lumbar flexion. Vascular claudication may resemble spinal stenosis, and some individuals have unilateral or bilateral symptoms radiating down the legs rather than true claudication.
The first symptoms of stenosis include lower back pain attacks. After a few months or years, this can lead to claudication. Pain may be radicular, following a classical neurological pathway. This occurs when the spinal cord or spinal cord becomes increasingly trapped in the smaller space inside the duct. It is difficult to determine whether the pain in the elderly is caused by a lack of blood supply or stenosis; testing can usually distinguish between them but the patient can have both vascular disease in the legs and spinal stenosis.
Among people with lower limb pain in combination with back pain, lumbar stenosis as the cause is twice as likely in those over 70 years while in those younger than 60 years the odds are 0.40. Pain characters are also useful for diagnosis. When discomfort does not occur while sitting, the lumbar spine stenosis likely increases significantly, about 7.4 times. Other features that increase the likelihood of lumbar stenosis are symptoms of forward bending (6.4), pain in both buttocks or legs (6.3 times), and neurogenic claudication (3.7 times). On the other hand, the absence of neurogenic claudication makes lumbar stenosis less likely as an explanation for pain.
Maps Lumbar spinal stenosis
Cause
Spinal stenosis may be congenital (rare) or acquired (degenerative), overlapping changes usually seen in aging spine.
Degenerative spondilolistesis
Forward displacement of the proximal vertebrae in relation to adjacent vertebrae in association with intact nerve arches, and in the presence of degenerative changes known as degenerative spondylolisthesis. Degenerative spondylolistesis narrows the spinal canal and the symptoms of spinal stenosis are common. Of these, neural claudication is the most common. Any slip of one vertebra to the other can cause spinal stenosis by narrowing the canal. If this forward channel narrows enough channels, and overwrites the contents of the spinal column, then it is a spinal stenosis by definition. If there are symptoms of related narrowing, the diagnosis of spinal stenosis is confirmed. With age, the occurrence of degenerative spondylolisthesis becomes more common. The most common spondylolistesis occurs with L4 slipping on L5. Frymoyer showed that spondylolisthesis with canal stenosis is more common in diabetic women who have undergone oophorectomy (removal of the ovaries). The causes of symptoms in the legs can be difficult to determine. Peripheral neuropathy secondary to diabetes can have the same symptoms as spinal stenosis.
Ankylosing spondylitis
Diagnosis
The diagnosis is based on clinical findings. Some patients may have narrow, asymptomatic channels, and do not require therapy. Stenosis can occur either as central stenosis (narrowing of the entire canal) or foraminal stenosis (narrowing of the foramen through which the nerve roots exit the spinal canal). The severe constriction of the lateral part of the duct is called "lateral recess stessosis". The flavum ligament (a yellow ligament), an important structural component adjacent to the posterior part of the dural sac (the neural sac) can become thickened and cause stenosis. The articular facet, also in the posterior part of the spinal cord, may become thickened and enlarged causing stenosis. This change is often called "tropical change" or "trophy facet" in radiology reports. When the channel becomes smaller, it resembles a triangular shape, this is called the "trefoil" channel.
The normal lumbar central canal has a midsagittal diameter (front to back) larger than 13 mm, with an area of ​​1.45 cm square. Relative stenosis is said to exist when the anterior-posterior channel diameter measures between 10 and 13 mm. The absolute stenosis of the lumbar canal is anatomically present when the anterior-posterior measurement is 10 mm. or less.
Plain X-rays from the lumbar spine or cervix may or may not show spinal stenosis. The definitive diagnosis is determined by CT (computerized tomography) or MRI scanning. Identifying the presence of narrow channels makes the diagnosis of spinal stenosis.
Gelderen van bikes
In 1977, Dyck and Doyle reported on a bicycle test, a simple procedure in which patients were asked to pedal a stationary bike. If the symptoms are caused by peripheral vascular disease, the patient will experience claudication, the sensation of not getting enough blood to the feet; if symptoms are caused by lumbar stenosis, the symptoms will disappear when the patient leans forward while cycling. Although diagnostic progress has been made with newer technical advances, bicycle tests remain an inexpensive and easy way to distinguish between claudication caused by vascular disease and spinal stenosis.
Magnetic resonance imaging
MRI is the preferred method for diagnosing and evaluating spinal stenosis of all areas of the spine, including the cervix, thorax and lumbar. MRI is useful for diagnosing cervical spondylotic myelopathy (degenerative arthritis of the cervical spine with associated damage to the spinal cord). Findings of cervical spinal cord degeneration in MRI may be unpleasant; this condition is called myelomalacia or umbilical cord degeneration. This is seen as an increasing signal on MRI. In myelopathy (spinal cord pathology) of degenerative changes, findings are usually permanent laminectomy and decompression will not reverse pathology. Surgery can stop the development of the condition. In cases where MRI changes are due to vitamin B-12 deficiency, a brighter outlook for recovery can be expected.
Set the diagnosis
Detection of spinal stenosis in the cervical spine, thorax or lumbar confirms only the presence of anatomy from stenosis conditions. It may or may not be correlated with the diagnosis of spinal stenosis based on clinical findings of radiculopathy, neurogenic claudication, weakness, bowel and bladder dysfunction, flexibility, motor weakness, hyperreflexia and muscle atrophy. These findings, taken from the patient's history and physical examination (along with anatomical demonstration of stenosis with MRI or CT scan), establish a diagnosis.
Management
Nonoperative therapy and laminectomy are standard treatments for LSS. Conservative treatment trials are usually recommended. Individuals are generally advised to avoid stressing the lower back, especially with extended spine. Physical therapy programs to provide core strengthening and aerobic conditioning may be recommended. Overall scientific evidence is inconclusive whether a conservative or surgical treatment approach is better for lumbar spine stenosis.
Drugs
The evidence for the use of medical interventions for lumbar spine stenosis is poor. Incalculated but non-nasal calcitonin may be useful for relieving short-term pain. Epidural block can also temporarily decrease pain, but there is no evidence of long-term effects. Adding steroids to these injections does not improve results; the use of controversial epidural steroid injections (ESI) and evidence of contradictory efficacy.
Non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants and opioid analgesics are often used to treat back pain, but evidence of less efficacy.
Surgery
Surgery seems to lead to better outcomes if there are ongoing symptoms after three to six months of conservative treatment. Laminectomy is the most effective of surgical treatments. In those who deteriorate despite conservative care operations leads to an increase of 60-70% of cases. Another procedure that uses an interspinous interference device known as X-STOP is less effective and more expensive when more than one spinal level is repaired. Both surgical procedures are more expensive than medical management.
Prognosis
Most people with mild to moderate symptoms do not get worse. While many increase in the short term after this repair surgery somewhat decreases with time. A number of factors that exist before surgery are able to predict outcomes after surgery, with people with depression, cardiovascular disease and scoliosis doing generally worse while those with more severe stenosis before and better overall health get better.
The natural evolution of disc disease and degeneration causes intervertebral joint stiffness. This leads to the formation of osteophyte - an excess of bone growth about the joint. This process is called spondylosis, and is part of the normal aging of the spine. This has been seen in the study of normal and painful thorns. Degenerative changes begin without symptoms as early as 25-30 years of age. Not infrequently people experience at least one case of severe lower back pain at the age of 35 years. These can be expected to improve and become less prevalent as individuals develop osteophyte formation around the disc.
In the US workers compensation system, after the threshold of two major spine surgeries is reached, most workers will never return to favorable forms of work. More than two spine surgeries, more possibilities make the patient worse, not better.
History
The LSS explanation was published by Sachs and Frankel in 1900, but the first LSS clinical description is usually associated with Dutch surgeon Henk Verbiest, whose report appeared in 1954.
Spinal stenosis began to be recognized as a disorder in the 1960s and 1970s. Porter and colleagues found that individuals with back pain and other symptoms tend to have fewer spinal canals than those without symptoms. Rothman reports that normal-sized lumbar canals are rarely seen in people with disc disease or those who require de-roofing procedures (laminectomy).
During the 1970s and 1980s, many case reports indicated successful surgical treatment rates, but these were based on subjective assessments by surgeons. In 1992, Johnsson, RosÃÆ' © n and UdÃÆ' nà © n described the natural history of LSS, with different conclusions about prognosis and treatment: "70% of patients reported no significant symptoms change, 15% showed significant improvement, whereas 15 % showed some deterioration.The investigators conclude that observation is a reasonable treatment option for lumbar stenosis and significant neurological damage is rare. "
Society and culture
United States
Under the rules endorsed by Title II and XVI of the United States Social Security Act, spinal stenosis is recognized as a condition of deactivation based on List 1.04 of C. This list states: "Lumbar spinal stenosis resulting in pseudoclaudication, defined by findings on imaging appropriate medical treatment, manifested by chronic nonadicular pain and weakness, and result in an inability to negotiate effectively, as defined in 1.00B2b. "This regulation was written specifically for lumbar stenosis; inclusion of cervical stenosis requires either meet or equal , depending on the uniqueness of the fact trier in the federal disability hearing.
References
External links
- "Diseases and conditions: Spinal stenosis". The Mayo Clinic. 2008-03-11 . Retrieved 2008-11-12 . link not found
Source of the article : Wikipedia
0 Comments