Spinal Stenosis

Question 1

What is spinal stenosis

Answer 1

Narrowing of the spinal cords, leading to compression of the spinal cords and nerve roots leading to subsequent radiculopathy

Question 2

Epidemiology and risk factors of spinal stenosis

Answer 2

Age, adults over. 50, more prevelance with age
Genetics for family may increase risk
Previous history of spinal injuries can contribute to the development
Congenital factors- some individuals are born with smaller spinal canals
Arthritis
Herniated discs
Obesity or sedentary lifestyle
Certain occupations
Certain conditions e.g pagers disease

Question 3

Clinical presentation of spinal stenosis

Answer 3

Located pain in the back, neck and radiating to the arms and legs
Numbness and tingling in the extremities
Weakness in the muscles due to compressed nerve roots/inervations
Claudication: pain or cramping in the legs, walking or standing that improves with rest (neurogenic claudication)
Balance issues
Bowel or bladder dysfunction in severe cases

Question 4

Systemic effects of spinal stenosis

Answer 4

Chronic pain, persistent pain decreases quality of ice and cuntional limitations
Receded mobility, patients may limit physical activity due to pain leading to deconditioning and muscular atrophy
Psychological impact, chronic pain and disability can contribute to anxiety, depression and social withdrawal
Sleep disturbances, pain may interfere with sleep patterns, leading to to fatigue and decreased overall wellbeing

Question 5

Pathology of spinal stenosis

Answer 5

Occurs due to degernative changes, including disc degeneration, facet hypertrophy/degernation and ligaments flavum thickening. These can lead to narrowing of the spinal cord and foramina : nerve exits.
Histiological- degenerative changes include loss of disc height, osteophyte formation (bone spurs) and thickening of surrounding ligaments ( flavum)

Question 6

Differential diagnosis of spinal stenosis

Answer 6

Herniated disc- similar symptoms due to nerve root compression
Spondylolithesis- forward displacement of vertebrae can lead to nerve compression
Peripheral neuropathy- never damage outside of the spinal cord mimics symptoms
Multiple sclerosis- may present with neurological symptoms
Tumours/infections- similar symptoms but should be ruled out

Question 7

Treatment of spinal stenosis

Answer 7

Conservative treatment
Steroid injections-epidural steroid injections reduce pain and inflammation temporary
Surgical options- laminectomy ( removal of part of the vertebrae )