Lumbar spinal stenosis

Lumbar spinal stenosis (LSS) is a narrowing of the spinal canal with cord or nerve root impingement resulting in radiculopathy or pseudoclaudication. It is a common diagnosis that is occurring with increased frequency in sports medicine clinics. Symptoms include radicular pain, numbness, tingling, and weakness. Peripheral vascular disease presents similarly and must be considered in the differential diagnosis. Imaging for LSS usually begins with plain radiographs, but often requires additional testing with MRI or CT myelography. There are currently limited controlled data regarding both conservative and surgical treatment of LSS. Most physicians agree that mild disease should be treated conservatively with medications, physical therapy, and epidural steroid injections. Severe disease appears to be best treated surgically; laminectomy continues to be the gold standard treatment.     

Lumbar spinal stenosis.

Recognition and management of problems inherent in spinal stenosis require a clear understanding of the diverse anatomic changes, their radiologic representations, and careful correlation with a wide spectrum of fluctuating clinical manifestations. Although a common basis might be postulated for narrowing of the spinal canal, emphasis should be placed on its various forms.     

Lumbar disk pseudotumor: an unusual presentation of lumbar spinal fracture and stenosis

We present an unusual case of a primary lumbar disk-space mass that presumably developed secondary to a chronic hyperextension spinal fracture associated with spinal stenosis. This injury resulted in the appearance of a lumbar intervertebral disk-space mass or pseudotumor. The pseudotumor most likely resulted from a prior spinal fracture, leading to a fused hyperextension deformity in a patient with underlying chronic degenerative spinal disease.     

Gait features for discriminating between mobility-limiting musculoskeletal disorders: Lumbar spinal stenosis and knee osteoarthritis

BackgroundFunctional ambulation limitations are features of lumbar spinal stenosis (LSS) and knee osteoarthritis (OA). With numerous validated walking assessment protocols and a vast number of spatiotemporal gait parameters available from sensor-based assessment, there is a critical need for selection of appropriate test protocols and variables for research and clinical applications.Research questionIn patients with knee OA and LSS, what are the best sensor-derived gait parameters and the most suitable clinical walking test to discriminate between these patient populations and controls?MethodsWe collected foot-mounted inertial measurement unit (IMU) data during three walking tests (fast-paced walk test-FPWT, 6-min walk test– 6MWT, self-paced walk test – SPWT) for subjects with LSS, knee OA and matched controls (N = 10 for each group). Spatiotemporal gait characteristics were extracted and pairwise compared (Omega partial squared – ω_p²) between patients and controls.ResultsWe found that normal paced walking tests (6MWT, SPWT) are better suited for distinguishing gait characteristics between patients and controls. Among the sensor-based gait parameters, stance and double support phase timing were identified as the best gait characteristics for the OA population discrimination, whereas foot flat ratio, gait speed, stride length and cadence were identified as the best gait characteristics for the LSS population discrimination.SignificanceThese findings provide guidance on the selection of sensor-derived gait parameters and clinical walking tests to detect alterations in mobility for people with LSS and knee OA.     

Cervical spinal stenosis.

Cervical spinal stenosis occurs at the craniovertebral junction, usually incident to a congenital malformation, or it appears as a developmental defect with diffuse narrowing of the cervical canal. In its acquired form the lesion may be limited to one or two levels, or it may be more extensive and affect three or more segments.     

Imaging lumbar spinal stenosis

The entire concept of spinal stenosis is based on the assumption that there is a minimal space necessary for the function of the neural content of the spinal canal, and this space, under certain circumstances, gets too small. This may seem self evident, but it was not until the middle of the previous century that there was sufficient focus on this concept to establish the diagnosis of lumbar spine stenosis.     

Lumbar spinal canal size of sciatica patients

Seven measures at the three lowest lumbar interspaces were recorded from conventional radiographs of the lumbar spines of 160 consecutive patients with low back pain and sciatica admitted for myelography and possible surgery. Eighty-eight patients were operated upon for disc herniation, and of the conservatively-treated 72 patients, 18 had a pathologic and 54 a normal myelogram. The results were evaluated after one year using the occupational handicap scales of WHO. Correlations of radiographic measures to stature were moderate and to age small. After adjusting for stature and age, only the male interpedicular distances and the antero-posterior diameter of intervertebral foramen at L3 were greater than those of females. The males with a pathologic myelogram had smaller posterior disc height at L3 and a smaller interarticular distance at L3 and L4 than those with normal myelogram, likewise the midsagittal diameter at L3 and L4 in females. In all patients other measures besides posterior disc height were smaller than those for low back pain patients (p less than 0.001) or for cadavers (p less than 0.001). The only correlation between measures and clinical manifestations was between pedicular length at L3 and limited straight leg raising. Where the disc material had been extruded into the spinal canal, the interpedicular distance was significantly wider. Only anterior disc height at L3 revealed differences between good and poor outcome one year after surgery, as did the interarticular distance at S1 in patients with normal myelogram after conservative treatment.     

The imaging of lumbar spinal stenosis

Lumbar spinal stenosis (LSS) is a relatively common condition of varied aetiology which results in chronic compression of the cauda equina. It becomes clinically relevant when giving rise to symptoms of neurogenic claudication or leg pain. Lumbar spinal stenosis can be classified based on anatomy or aetiology and the diagnosis in any single case should include a consideration of both the site and the cause. Plain radiography is of limited value. Myelography with erect lateral flexion/extension views will demonstrate the dynamic component of the stenosis which cannot be appreciated on plain computed tomography (CT) or magnetic resonance imaging (MRI). Therefore, in patients with a good history of symptomatic LSS, and a borderline stenosis on MRI, CT myelography is recommended as the definitive pre-operative imaging investigation.     

腰椎管狭窄症的CT诊断

腰椎管狭窄症可分为原发性和继发性两大类,本文主要分析继发性腰椎管狭窄症,临床上多见.笔者自1995～2003年共搜集180例腰椎管狭窄症病例,回顾分析其临床特点及CT表现,以提高对本病的认识.     

Epidural venous stasis in spinal stenosis

Summary Computed tomography permits reliable demonstration of the spinal canal and its contents. Measurements of the sagittal diameter of the bony canal do not take into consideration size, shape and state of intraspinal soft tissue structures, i.e. the thecal sac and its own contents, epidural fat and blood circulation pattern. Three particularly illustrative cases were selected in which obvious epidural venous engorgement was visualized in association with spinal stenosis. The authors think that epidural venous stasis occuring in segmental spinal stenosis is a CT sign of clinically significant narrowing of the neural canal. Accurate recognition of the type of lumbar stenosis together with epidural blood flow alterations permits a better understanding of the existing lesions. Thus, a more precise and specific surgical approach is possible.     

老年人腰椎椎管狭窄的CT评估

目的：描述６０岁以上老年人脊椎狭窄的有关ＣＴ表现及测量,探讨老年人脊椎狭窄的特征。方法：采用ＣＴ横断而簿层扫描,并测量硬膜囊矢状径、黄韧带前间隙、侧隐窜宽度,分析他们与脊央和／或神经根受压的关系。结果：硬膜囊矢状径≤１０ｍｍ、黄韧带前间隙〈５ｍｍ,侧陷窝宽度≤３ｍｍ,常提示压迫脊髓或神经根。结论：老年人椎管狭窄多有椎骨小关节及侧隐窝狭窄,而黄韧带前间隙〈５ｍｍ是神经根压迫较为可靠的依据。     

CT引导硬膜外皮质类固醇注射治疗腰椎椎管狭窄

目的评价CT引导经神经孔硬膜外皮质类固醇注射治疗腰椎椎管狭窄的短期及长期疗效。方法经CT证实存在腰椎椎管狭窄且保守治疗无效的36例患者,于CT引导下行硬膜外皮质类固醇注射治疗。通过患者治疗前、治疗后2周及治疗后1年的视觉模拟疼痛评分以评价其疗效。结果对所有36例患者行治疗后2周及1年随访,19例(52．8％)患者有较好短期疗效,其中15例(41．6％)患者有较好长期疗效。15例患者(41．6％)对此治疗短期疗效表示满意。12例(33．3％)患者对其长期疗效表示满意。结论CT引导经神经孔硬膜外类固醇注射可以缓解部分腰椎椎管狭窄患者的疼痛症状并改善患者的生活质量。     

Lumbar spinal nerves in the neural foramen: MR appearance

The appearance of the proximal lumbar spinal nerves at magnetic resonance (MR) imaging has not, to the authors' knowledge, been described. MR images and exactly corresponding sections obtained from four cadavers by means of a freezing microtome were correlated to characterize the MR appearance of the proximal spinal nerves. The junction of the dorsal and ventral rami with the dorsal and ventral roots consists of a group of six to 15 fascicles measuring 2-6 mm in length. These fascicles appear in MR images obtained with short repetition times as small foci of lower signal intensity than that of surrounding fat. The proximal spinal nerve and its relationship to the intervertebral disk and osseous margins of the neural foramen can be demonstrated effectively with MR imaging.     

Upper cervical spinal cord compression due to bony stenosis of the spinal canal

Compression of the upper cervical spinal cord due to stenosis of the bony spinal canal is infrequent. In the first case reported here, stenosis was due to acquired extensive, unilateral osteophytes centered on the left apophyseal joints of C1–C2 in an elderly professional violinist. In the second case, stenosis was secondary to isolated congenital hypertrophy of the laminae of C1 and C2.