Spinal Stenosis Flashcards
Definition
Narrowing of spinal canal, less overall space for the spinal cord to run.
Long term consequence of degeneration and OA
Can put pressure on the spinal cord and nerves that travel through the spine.
Occurs most often in the lower back and neck.
More dangerous in the neck, due to the compression of the spinal chord potentially leading to serious symptoms.
Aetiology
Can be congenital, often from being born with short pedicles, which bring the anterior and posterior part of the spinal canal closer together making it smaller.
Bone spurs:
– results of degeneration of the spine, causing osteophytes to form, which can narrow the space in the spinal canal. Pagets disease can cause this.
Herniated discs:
– if disc herniates it can press on the spinal cord or nerve roots meaning that there is less room for them to run
Thick ligaments:
– resultant of degeneration, over time ligaments like ligamentum flavum can become thick and stiff. Then they can push into the spinal canal.
Tumors:
– rarely, tumors can form inside the spinal canal
Spinal injuries:
– Car accidents and other type of trauma, (sports etc).
Bone diseases:
– pagets disorder and achondroplasia
Investigations
X-rays:
– can show bone changes within the spine, and show what may be making the spinal canal smaller.
MRI (magnetic resonance imagine):
– provides detailed images of hard and soft tissue. The test can detect damage to the discs and ligaments, also can show tumors.
CT (computerised tomogrophy) scan:
– combines x-ray taken from many different angles. In CT pyelogram, a contrast dye is injected to outline the spinal cord and nerves. This can show herniated discs, bone spurs and tumors.
Treatment
Treatment can depend on how severe the symptoms are.
Medications:
– NSAIDS- relieve pain and inflammation
– antidepressants- nightly doses of amitriptyline, can help ease chronic pain
– opioids- oxycodone, codeine and others (watch as they can become very addictive and habit forming
– anti-seizure drugs- (gabapentin), used to reduce pain caused by damaged nerves
physical therapy:
– speak to a physical therapist/osteopath that can teach you the right exercises to:
—- build up your strength and endurance
—- maintain the flexibility and stability of spine
—- improve balance
Conservative treatment:
– accupuncture, massage, hot and cold therapy, targeted muscle strengthening excercises
Steroid shots:
– injecting steroid shots around damaged and inflamed area may be able to reduce inflammation and swelling.
– however may not be the best choice, as some studies have shown its no better than receiving numbing medicine alone.
Needle procedure to remove some of the ligament
Surgery:
– laminectomy- removes the lamina of the vertebrae. eases pressure on the nerves
– laminoctomy- removes only part of the lamina of the vertebrae.
– laminoplasty- only done in the neck, creates a hinge in the lamina, making the spinal canal bigger. Metal hardware bridges the gap in the opened section of the spine
Surgery risks:
– infection
– blood clot in leg vein
– tear in the membrane that covers the spinal cord
Clinical presentation:
CSP:
– neck pain
– trapezial pain
– pain on neck movement
– degenerative pain, worse in mornings and with start up activity, better with movement, improving during the day
– increasing pain at night
– tingling numbness in the upper extremity (radicular pain)
LSP:
– degenerative pain, worse in mornings and with start up activity, gets better throughout the day after moving it
– back and leg pain in one or both legs
– sciatica
– cauda equina can be caused
– holding LSP in extended position may reproduce back pain
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