Spinal stenosis is a medical condition where the spinal canal narrows and pinches the spinal cord and nerves, usually due to disc herniation or a tumour. This may affect the cervical spine, the lumbar spine or both. Lumbar spinal stenosis results in low back pain as well as pain or abnormal sensations in the legs.
Cervical Spine Stenosis
The main causes of cervical spine (CS) stenosis include cervical spondylosis, diffuse idiopathic skeletal hyperostosis (DISH), or calcification of the posterior longitudinal ligament. CS stenosis is more common in males than females, and is mainly found in the 40-60 year age group.
Signs of CS stenosis 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 in reflexes. The best diagnostic and investigative tool is magnetic resonance imaging (MRI), and computed tomograghy (CT) is not useful.
If the problem is mild, treatment may be as simple as physiotherapy and the use of a cervical collar. If severe, treatments include laminectomy or decompression.
Lumbar Spine Stenosis
The main causes of lumbar spine (LS) stenosis include hypertrophy of the facet joints; 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 LS stenosis include neurogenic claudication that causes leg pain, weakness, and loss of deep tendon reflexes. 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.
As with CS stenosis, MRI is the best imaging procedure, though unlike with CS stenosis, CT may be somewhat useful, and can be used if MRI is unavailable.
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.
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