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Musculoskeletal PT 2 > Spinal Stenosis > Flashcards

Spinal Stenosis Flashcards

1
Q

What is spinal stenosis

A
  • narrowng of spinal canal or Intervertebral foramen
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2
Q

Lumbar spinal stenosis incidence

A
  • 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
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3
Q

what is one predisosing factor to LS stenosis

A
  • DM
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4
Q

What can spinal stenosis cause compression of

A
  • spinal cord
  • spinal nerves
  • cauda equina (LMN signs)
  • blood vessels
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5
Q

Classifications of spinal stenosis

A

Congential
acquired

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6
Q

Classifications of spinal stenosis

Congential

A
  • 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

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7
Q

Classifications of spinal stenosis

Acquired

results from

A

Result of

  • degenerative changes
  • posterior disc encroachment
  • tumors, space occupying lesions
  • iatrogenic (result of surgery)
  • post-op fibrosis
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8
Q

Atrogenic spinal stenosis

A
  • acquired as a result of surgery
  • post-op instability
  • spondylolisthesis: slip of superior vertebrae on inferior
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9
Q

Classifications of spinal stenosis

combined

A
  • congential anomalies
  • AND
  • acquired changes
  • can cause narrowing of spinal canal and intervetrebal foreman
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10
Q

Types of Spinal stenosis

A
  • central canal spinal stenosis
  • Lateral Foraminal stenosis
  • Disc herniation (extrusion) cauing lateral foraminal stenosis
  • Cauda equina stenosis
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11
Q

Types of Spinal stenosis

Central canal stenosis

what happens and what causes it

A
  • 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
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12
Q

Types of Spinal stenosis

Central Canal stenosis Signs and symtpoms

A
  • stenotic central canal with compressed thecal sac
  • UMNS
  • hyperreflexia
  • hypertonicity
  • (+) babinski
  • (+) hoffmans (more related to C/S)
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13
Q

Types of Spinal stenosis

Central canal Stenosis: MRI

A
  • 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
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14
Q

Types of Spinal stenosis

Lateral foraminal Stenosis

what is it/causes

A
  • narrowing of IV foreman

Causes

  • Degernative disc disease
  • radial bulging
  • facet joint osteophytes
  • vertebral body osteophytes
  • hypertrophy of ligament flavum
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15
Q

Types of Spinal stenosis

Review imaging

A
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16
Q

Types of Spinal stenosis

Disc herniation (extrusion) causing lateral foraminal stenosis

A
  • disc herniation into lateral foramina
  • NR compression from annulus buldge and nulceus moving posterior
17
Q

Types of Spinal stenosis

Lateral foraminal stenosis instability causes

other causes other than a disc encrotachment

A
  • spondylolithesis - slip of a vertebrae on another
  • grade 3-4 slip more likely to produce neural signs
  • Fractures
  • tumors
18
Q

Types of Spinal stenosis

Lateral foraminal stenosis Signs and symptoms

A
  • Pain, paresthesia in a dermatome
  • myotomal weakness
  • reflex change (hyporeflexive)
19
Q

Types of Spinal stenosis

Cauda Equina syndrome

A
  • 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
20
Q

Review Outcome measure on LS spinal stenosis

A

assist with DX

21
Q

LBP classification: exercise subgroup

A
  • flexion preference
  • Traction subgroup
22
Q

LBP classification: exercise subgroup

Flexion preference

typical presentation

A
  • 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
23
Q

LBP classification: exercise subgroup

Traction subgroup

A
  • no response to exercise (no centralization)
  • (+) imaging of NR involvement
  • S&S of radiculopathy
  • some groups benefit from traction
24
Q

PT treatment with central canal stenosis

A
  • 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
25
Q

Red flags with spinal stenosis

A
  • UMN cord signs
  • caude equina syndrome
  • unexplained neurological symptoms
  • vascular conditions
  • refer to MD
26
Q

Look at additional PT treatment for stenosis

A

LOOK
Slide 29

27
Q

Treatment for spinal stenosis that is non pT

A
  • 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
28
Q

Reasons for Surgical treatment for stenosis

A
  • when conservative measures do not decrease symptoms
  • when a person can no longer walk and preform ADLs
29
Q

Surgeries for spinal stenosis

A
  • decompressive surgery
  • foramenotomy (enlarge IV forman)
  • lumbar laminectomy - with or without fusion
  • fusion for unstable spondylolisthesis
30
Q

Spinal stenosis less invasive surgery option

A
  • 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

Musculoskeletal PT 2 (25 decks)

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