Spinal stenosis

Spinal stenosis refers to the collapse spinal canal anywhere along its axis. Although the condition usually results gained by degenerative changes (spondylosis), spinal stenosis can be congenital and nature. Components that contribute to spinal stenosis gained curpind Fate joints yellow ligament, posterior longitudinal ligament, vertebral corpus, intervertebral disc and epidural fat.
Acute pain and chronic neck and lower back is a major health problem. 75% of the entire population has experienced back pain at some point in life. Most patients who have acute episode of back pain recover without surgery, while 3-5% of them have a herniated disc and 1-2% nerve root compression. Older patients with symptoms of chronic or recurrent spinal degenerative disease. Progressive collapse of the spinal canal can occur alone or in combination with acute disc herniation. Congenital stenosis have gained places the patient at high risk for acute neurological injury.
Spinal stenosis may predispose a person with mild degenerative changes in the development of neurogenic symptoms early in life.Spinal stenosis is common in cervical and lumbar areas. Can cause cervical stenosis and myelopathy thoracic spinal compression. Lumbosacral region of spinal stenosis cause radicular pain, neurogenic claudication, or both. Lateral spinal canal stenosis in any region lead to nerve root compression.Patients may experience radicular pain, weakness and numbness on the affected spinal nerve distribution.
Spinal stenosis can cause significant morbidity. Primary symptoms are pain, paresthesia and motor weakness. Severe disability and death may result from the association of cervical stenosis and a minor trauma. Cervical and lumbar stenosis may cause chronic pain and motor weakness. Severe lumbar stenosis is associated with horse tail syndrome.
Treatment can be conservative or surgical. Conservative regimes include rest, physical therapy with exercises for muscle strength paraspinala, tijarea, use appropriate postural biomechanics, medication non-steroidal anti-inflammatory, analgesic and antispasmodic. Surgical decompression is indicated in people who experience incapacitating pain, claudication, neurological deficit or myelopathy. Simultaneous stabilization is reserved for people that segmental instability is suspected.
Pathogenesis of spinal stenosisCervical and thoracic stenosis:Pathophysiology of spinal stenosis is related to bone marrow dysfunction caused by a combination of mechanical compression and degenerative instability. With the aging and degenerating intervertebral disc collapses, leading to the formation of spurs. This phenomenon is most common at C5-6 and C 6-7. Degeneration and abnormal motion and instability with anterolisteza retrolisteza (subluxarea vertebral body) cause spinal cord compression. Bone is subjected to repetitive injury other injuries of the neck dynamics through normal Iscar. Our employees to combine the factors leading to clinical myelopathy.Other conditions that lead to skeletal and deformation of spinal canal stenosis are rheumatoid arthritis, ankylosing spondylitis and ossification of posterior longitudinal ligament. Genetic factors play a role in the geographic prevalence of these conditions.Lumbar stenosis:Pathophysiology of disc degeneration and facet arthropathy cause herniated disk in Posterolateral region causing nerve root incarceration. Degeneration of the disc also leads to changes that affect the stability of the spine movements. Bone spurs and spurs formed at the edge of the disc appear as a result of instability.Joint and ligament hypertrophy yellow girls contributes to lateral canal stenosis with neurogenic claudication, radiculopathy.
Neuroprocesele central canal and can be compromised by tumor infiltration such as metastatic spine disease or infectious spondylitis. An abscess can compress the spinal cord if it is contained directly in the epidural space, while dischiita and vertebral osteomyelitis may compress the spinal cord after spinal colanpsul. Paget's disease detemina spinal stenosis as a result of enlargement of the vertebral body, while the posterior longitudinal ligament ossification idiopathic directly destroy the spinal canal in the thoracic and cervical region.
Signs and symptoms in spinal stenosisCervical and thoracic stenosis:Congenital spinal stenosis may predispose to spinal myelopathy as a result of minor trauma or spondylosis. Cervical spondylosis refers to degenerative changes associated with aging. These changes include intervertebral disc degeneration, disc space collapse, the formation of spurs, joint and ligament hypertrophy yellow girls, all the spinal canal can lead to collapse. Cervical spondylosis myelopathy refers to the clinical picture caused by these changes. It is most commonly found cause of marrow dysfunction in adults over 55 years. Cervical spine degenerative changes are seen in over 95% of asymptomatic individuals over 65 years. Myelopathy is considered to grow at 20% of people with spondylosis.
Initial symptoms can be subtle loss of dexterity of the hand and proximal lower extemitatii without neck or arm pain. The progression appears cvadripareza spastic. Pathological reflexes such as Hoffman sign, clonus, Babinski reflex reflex hyperreflexia may enlarge. Some patients have ataxia and compression associated with copies spinocerebelare.If there is incarceration roots associated cervical radicular pain patients experience sharp hit in the arm with numbness and weakness. Depending on the level of some reflexes of the upper extremity may be depressed or absent. Men older than 55 years are most affected.Lumbar stenosis:Patients with significant spinal canal collapse reported pain, weakness, numbness in the legs during ambulatiei. Onset of symptoms during ambulatiei is believed to be caused by high metabolic demands of the compressed nerve roots that become ischemic by stenosis. This phenomenon is neurogenic claudication. Pain is relieved when the patient flexes the spine.Flexion increases the canal size by stretching protruzionat yellow ligament, and facet reduction and enhancement laminelor foramen.Improving the existing pressure on the nerve roots decreases pain.L5 nerve is most affected by muscle weakness associated with the extensor longus halucis.Neurogenic claudication:Pain is exacerbated by neurogenic claudication and Descent bipedal position and is relieved by stairs supinatie position of the body, lumbar flexion, squat and sit. Pain from the neurogenic vascular caldicatia is exacerbated by bike, climbed and lumbar flexion and is not relieved by rest. Patients compensate symptoms by flexing forward, slow pace and the distances of outpatient departments. Unfortunately, these compensatory measures, particularly in elderly osteoporotic women and promotes progression vertebral fracture. The pain radiates down into the neurogenic claudication, irradiation up to the States in the vascular.
The differentiation between neurogenic and vascular claudication is important because treatments that are different implications.Vascular claudication is a manifestation of peripheral vascular disease and arteriosclerosis. On physical examination the patient with neurogenic claudication must not reveal murmurs pressure, arterial pulse pedia to be normal coloration and skin disorders, the turgorului and temperature must be absent.
Evolution of Spinal stenosis:Cervical spinal stenosis progresses to more than one third of patients. Among the initial symptoms of neurogenic damage occurs, followed by a period of stability (several years) and secondary progression of myelopathy. Unfortunately late myelopathy by decompression treatment reduces neurological deficit not in all. Natural evolution of lumbar stenosis is not well understood. A slow progression occurs in all affected persons.Even with significant collapse of these people will not develop acute ponytail syndrome in the absence of significant disc herniation. Ponytail syndrome has the following symptoms: urinary retention, buttocks anesthesia, loss of rectal tone, loss of righting reflex bulbocavernos. Slow progression of lumbar spinal dysfunction usually leads to a feeling of heaviness in the legs only relieved by rest periods. Rarely a joint synovial cyst of girls will lead to severe stenosis and subacute radiculopatiei development characterized by pain and weakness.