Spinal Stenosis Flashcards
What is spinal stenosis
- narrowng of spinal canal or Intervertebral foramen
Lumbar spinal stenosis incidence
- approximately 5% of all LBP
- more common in L/S than C/S then T/S
- age over 50 insidious onset/over time
- men>women
what is one predisosing factor to LS stenosis
- DM
What can spinal stenosis cause compression of
- spinal cord
- spinal nerves
- cauda equina (LMN signs)
- blood vessels
Classifications of spinal stenosis
Congential
acquired
Classifications of spinal stenosis
Congential
- developmental abnormalities (young age)
- malformation of vertebral arch
- shorter pedicular length resulting in a smaller cross sectional spinal canal area
- symptoms present younger
- have fewer degenerative changes and multiple levels of involvement
frefoil shape - traingular malformation
Classifications of spinal stenosis
Acquired
results from
Result of
- degenerative changes
- posterior disc encroachment
- tumors, space occupying lesions
- iatrogenic (result of surgery)
- post-op fibrosis
Atrogenic spinal stenosis
- acquired as a result of surgery
- post-op instability
- spondylolisthesis: slip of superior vertebrae on inferior
Classifications of spinal stenosis
combined
- congential anomalies
- AND
- acquired changes
- can cause narrowing of spinal canal and intervetrebal foreman
Types of Spinal stenosis
- central canal spinal stenosis
- Lateral Foraminal stenosis
- Disc herniation (extrusion) cauing lateral foraminal stenosis
- Cauda equina stenosis
Types of Spinal stenosis
Central canal stenosis
what happens and what causes it
- spinal cord compression
Causes:
- degenerative changes such as
- osteophytes on vertebral bodies (lipping), facet joints
- ligamentum flava hypertrophy and bulging
- DD/Disc radial bulging
- Spondylolisthesis: slippage of vertebrea
- Tumors, space occupying lesions
Types of Spinal stenosis
Central Canal stenosis Signs and symtpoms
- stenotic central canal with compressed thecal sac
- UMNS
- hyperreflexia
- hypertonicity
- (+) babinski
- (+) hoffmans (more related to C/S)
Types of Spinal stenosis
Central canal Stenosis: MRI
- modic = endplate of vertrebal disc gets damaged and disc can encrotch into body
- Can get discitis by bacterial infection that can got into endplatebody
- Loss of disc space, buldging disc, osteophytes, vertrebal lipping
- modic changes typically around enplate L4/L5
Types of Spinal stenosis
Lateral foraminal Stenosis
what is it/causes
- narrowing of IV foreman
Causes
- Degernative disc disease
- radial bulging
- facet joint osteophytes
- vertebral body osteophytes
- hypertrophy of ligament flavum
Types of Spinal stenosis
Review imaging
Types of Spinal stenosis
Disc herniation (extrusion) causing lateral foraminal stenosis
- disc herniation into lateral foramina
- NR compression from annulus buldge and nulceus moving posterior
Types of Spinal stenosis
Lateral foraminal stenosis instability causes
other causes other than a disc encrotachment
- spondylolithesis - slip of a vertebrae on another
- grade 3-4 slip more likely to produce neural signs
- Fractures
- tumors
Types of Spinal stenosis
Lateral foraminal stenosis Signs and symptoms
- Pain, paresthesia in a dermatome
- myotomal weakness
- reflex change (hyporeflexive)
Types of Spinal stenosis
Cauda Equina syndrome
- compression of cauda equina (lower sacral NRs
- large central hernation
- tumor
- causes LMN S&S
- presentation: paresthesia/anesthesia in S3-S4 “saddle” region
- bowel and bladder dysfunction
- ED-gential/sexual dysfunction
- IMMEDIATE referral
Review Outcome measure on LS spinal stenosis
assist with DX
LBP classification: exercise subgroup
- flexion preference
- Traction subgroup
LBP classification: exercise subgroup
Flexion preference
typical presentation
- older age greater than 50
- preference for flexion
- symptoms of intermittent claudication
- imaging evidence of lumbar spinal stenosis
- side bend to one side may also make it better
LBP classification: exercise subgroup
Traction subgroup
- no response to exercise (no centralization)
- (+) imaging of NR involvement
- S&S of radiculopathy
- some groups benefit from traction
PT treatment with central canal stenosis
- flexion exercise program
- avoid extension
- function in posterior pelvic tilt
- lessen L/S hypomobility and compression
- release tight myofascia
- release tight facets
- reduce shock - cushion shoes and insoles
Red flags with spinal stenosis
- UMN cord signs
- caude equina syndrome
- unexplained neurological symptoms
- vascular conditions
- refer to MD
Look at additional PT treatment for stenosis
LOOK
Slide 29
Treatment for spinal stenosis that is non pT
- anti-inflammatory meds, NSAIDS
- Epidural steriod injections
- cortisone injection into the epidural space
- typically 3 injections over a period of months
- not curative
- alleviates pain in about 50% of cases
Reasons for Surgical treatment for stenosis
- when conservative measures do not decrease symptoms
- when a person can no longer walk and preform ADLs
Surgeries for spinal stenosis
- decompressive surgery
- foramenotomy (enlarge IV forman)
- lumbar laminectomy - with or without fusion
- fusion for unstable spondylolisthesis
Spinal stenosis less invasive surgery option
- interspinous process distraction spacer
- widens foramen
- takes buckling/bulging out of ligaments and discs which cause narrowing and compression
- allows motion but limits extension
- less likely to help if bone spur formation is causing lateral foraminal stenosis
