spinal stenosis

Question 1

lumbar spinal stenosis
- definition
- causes of impingement

Answer 1

reduction in the diameter of the lumbar central and lateral spinal canal due to bone and soft tissue structures

Causes of impingement:
Bony
- osteophytes
- spondylolisthesis

Soft tissue
- synovial cysts
- hypertrophied ligamentum flavum
- disc prolapse

Question 2

Classification of stenosis

Answer 2

Causes:
Congenital
* achondroplasia - short pedicles and medial facets

Acquired
* traumatic
* post surgical
* inflammatory - AS
* degenerative - most common

Anatomy:
Central
* typically anterior disc and posterior hypertrophied ligamentum flavum
* if L4/5 - then L5 nerve root affected

lateral recess
* facet joint hypertrophy
* osteophyte
* affects the forming nerve root - so for L4/5 - L5 is affected

Foraminal
- between medial and lateral borders of the pedicle
- affects the exiting nerve root - for L4/5 - L4 is affected

Extra-foraminal
- affects exiting nerve root - L4 for L4/5

Question 3

assessment of spinal stenosis

Answer 3

symptoms
- back pain
- buttock pain
- claudication

signs
- often normal

Imaging
- standing xrays - spinolisthesis
- MRI

Question 4

lumbar spine stenosis management

Answer 4

Non-op
* analgesia
* physio
* steroid injection - facet joint

Operative
Indications:
* worsening symptoms
* 6 month symptoms
* cauda equina

Options:
* laminotomy
* laminectomy
* fusion

Question 5

pedicle to pedicle decompression

Answer 5

Question 6

differences between spinal stenosis and disc disease

Answer 6

Question 7

SPORT trial findings

Answer 7

spine patient outcomes research trial
three main causes of back pain
1. disc prolapse
2. spinal stenosis
3. degenerative spondylolisthesis

survery vs non-op
- disc - both improve but quicker with non-op
- spinal stenosis - surgery better
- degenerative spondylolisthesis - surgery better if associated with spinal stenosis