Lumbar Stenosis Flashcards
What is the leading pre-operative diagnosis for adults older than 65 years who undergo spine surgery?
Spinal Stenosis
What is entrapment of the Cauda Equina or root(s) by hypertrophy of the osseous and/or soft tissue structures surrounding the lumbar spinal canal?
Spinal stenosis
What range should the A-P diameter of the lumbar spinal canal be?
15-23mm
With spinal stenosis, what can happen in the front that narrows the canal?
Vertebral spurs and disc bulging
With spinal stenosis, what can happen on the sides that narrows the canal?
Facet Spurs
With spinal stenosis, what can happen in the back that narrows the canal?
Lamina enlargement and thickened ligament
What does the canal diameter have to be in order to be associated with claudication?
10-12mm
What is Neurogenic claudication?
Compression of the microvasculature that supplies the lumbar nerve roots
Why are some compressions symptomatic?
When the spinal nerves’ nutrient supply is cut off and their venous return is impaired
What is the primary reason that compressed nerves become pain generators?
Impairment of venous return
What is cramping due to small vessel disease in the lower extremity?
Ischemic Claudication
What muscle is the most prone to ischemic claudication?
Gastrocnemius
Why is the Gastrocnemius the most prone to ischemic claudication?
Highest number of muscle fibers per motor neuron
Densest muscle in the body
Highest gross oxygen consumption than any other muscle
What occurs at the IVD level between 2 ADJACENT DEGENERATING DISCS that has a midline sagittal spinal canal diameter narrowing that may elicit neurogenic claudication (NC) or pain in the buttock, thigh, or leg
Central Canal Stenosis
What is narrowing (less than 3-4 mm) between the facet superior articulating process and posterior vertebral margin?
Lateral Recess Stenosis
What are the 4 zones of lateral recess stenosis?
Entrance zone
Mid-zone
Exit zone
Far-Out zone
Which zone stenosis arises from facet joint SAP hypertrophy?
Entrance zone stenosis
Which zone stenosis arises from osteophytosis under the pars interarticularis and bursal or fibrocartilaginous hypertrophy at a spondylolytic defect?
Mid-zone stenosis
Which zone stenosis arises from facet joint hypertrophy and subluxation, as well as superior disc margin osteophytosis.
Exit zone stenosis
Which zone stenosis arises with far lateral vertebral body endplate osteophytosis and when the sacral ala and L5 transverse process impinge on the L5 spinal nerve?
Far-Out zone stenosis
What is Simian Posture?
Flexed Hip, Knee, and Low Back
What does the Bike test conclude?
If pt can ride longer than they can walk consider neurogenic claudication
What does the Stoop test conclude?
If Px can walk further with a flexed posture more than walking upright consider neurogenic claudication
What is the best way to treat spinal stenosis non-operative?
Flexion-Distraction
