Lumbar Stenosis

Question 1

What is the leading pre-operative diagnosis for adults older than 65 years who undergo spine surgery?

Answer 1

Spinal Stenosis

Question 2

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?

Answer 2

Spinal stenosis

Question 3

What range should the A-P diameter of the lumbar spinal canal be?

Answer 3

15-23mm

Question 4

With spinal stenosis, what can happen in the front that narrows the canal?

Answer 4

Vertebral spurs and disc bulging

Question 5

With spinal stenosis, what can happen on the sides that narrows the canal?

Answer 5

Facet Spurs

Question 6

With spinal stenosis, what can happen in the back that narrows the canal?

Answer 6

Lamina enlargement and thickened ligament

Question 7

What does the canal diameter have to be in order to be associated with claudication?

Answer 7

10-12mm

Question 8

What is Neurogenic claudication?

Answer 8

Compression of the microvasculature that supplies the lumbar nerve roots

Question 9

Why are some compressions symptomatic?

Answer 9

When the spinal nerves’ nutrient supply is cut off and their venous return is impaired

Question 10

What is the primary reason that compressed nerves become pain generators?

Answer 10

Impairment of venous return

Question 11

What is cramping due to small vessel disease in the lower extremity?

Answer 11

Ischemic Claudication

Question 12

What muscle is the most prone to ischemic claudication?

Answer 12

Gastrocnemius

Question 13

Why is the Gastrocnemius the most prone to ischemic claudication?

Answer 13

Highest number of muscle fibers per motor neuron
Densest muscle in the body
Highest gross oxygen consumption than any other muscle

Question 14

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

Answer 14

Central Canal Stenosis

Question 15

What is narrowing (less than 3-4 mm) between the facet superior articulating process and posterior vertebral margin?

Answer 15

Lateral Recess Stenosis

Question 16

What are the 4 zones of lateral recess stenosis?

Answer 16

Entrance zone
Mid-zone
Exit zone
Far-Out zone

Question 17

Which zone stenosis arises from facet joint SAP hypertrophy?

Answer 17

Entrance zone stenosis

Question 18

Which zone stenosis arises from osteophytosis under the pars interarticularis and bursal or fibrocartilaginous hypertrophy at a spondylolytic defect?

Answer 18

Mid-zone stenosis

Question 19

Which zone stenosis arises from facet joint hypertrophy and subluxation, as well as superior disc margin osteophytosis.

Answer 19

Exit zone stenosis

Question 20

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?

Answer 20

Far-Out zone stenosis

Question 21

What is Simian Posture?

Answer 21

Flexed Hip, Knee, and Low Back

Question 22

What does the Bike test conclude?

Answer 22

If pt can ride longer than they can walk consider neurogenic claudication

Question 23

What does the Stoop test conclude?

Answer 23

If Px can walk further with a flexed posture more than walking upright consider neurogenic claudication

Question 24

What is the best way to treat spinal stenosis non-operative?

Answer 24

Flexion-Distraction