Spinal Cord Disease - Spinal Stenosis

Question 1

What is Spinal Stenosis?

Answer 1

Narrowing of part of the spinal cord - compression of the spinal cord or nerve roots.

Question 2

Which parts of the spine are usually affected by Spinal Stenosis?

Answer 2

Cervical or Lumbar (commonest).

Question 3

Epidemiology of Spinal Stenosis.

Answer 3

Likely Above 60 - Degenerative Changes.

Question 4

Types of Spinal Stenosis (3).

Answer 4

1. Central - Narrowing of Central Canal.
2. Lateral - Narrowing of Nerve Root Canal.
3. Foramina Stenosis - Narrowing of Intervertebral Foramina.

Question 5

Aetiology of Spinal Stenosis (7).

Answer 5

1. Congenital.
2. Degenerative Changes.
3. Herniated Disc.
4. Thickening of Ligaments.
5. Spinal Fracture.
   6 .Spondylolisthesis.
6. Tumours.

Question 6

Pathophysiology of Degenerative Changes (4).

Answer 6

1. Biochemical Changes - Cell Death and Loss of Proteoglycan and Water : Progressive Disk Bulging.
2. Increased Stress Transfer to Posterior Facet Joints.
3. Cartilaginous Degeneration, Hypertrophy and Osteophyte Formation.
4. Thickening and Distortion of Ligaments Flavum.

Question 7

Clinical Features of Spinal Stenosis (4).

Answer 7

1. Gradual Onset (Not Acute).
2. Dependent on Degree of Narrowing and Site (can go to Cauda Equina).
3. Intermittent Neurogenic Claudication/Pseudoclaudication (Central Stenosis).
4. Absent at Rest, Flexing Improves, Extending Worsens.

Question 8

Key Features of Intermittent Neurogenic Claudication (3).

Answer 8

1. Lower Back Pain.
2. Buttock and Leg Pain.
3. Leg Weakness.

Question 9

Investigations of Spinal Stenosis (2).

Answer 9

1. MRI.

2. Exclude Peripheral Arterial Disease.

Question 10

Management of Spinal Stenosis (4).

Answer 10

1. Exercise and Weight Loss.
2. Analgesia.
3. Physiotherapy.
4. Decompression Surgery e.g. Laminectomy.