Introduction
Spinal stenosis is a condition of the spinal canal where as a result of various end stage disease processes there is a narrowing of the opening (in this case in the lumbar spine), through which the spinal cord travels.
This leads to an irritation of the spinal cord and eventually to pinching and damage of the spinal cord. Symptoms are usually back pain at the particular height where the stenosis is located and symptoms in the muscles that are innervated by the pinched nerves that originate below the level of the stenosis.
A stenosis in the lower level of the lumbar spine would lead to a loss in strength of the leg muscles, a loss of muscle mass and pain irradiating into the legs and feet. There may also be a loss of sensitivity because of pressure onto the nerves that supply sensitivity signals from the leg to the spinal cord. The patient may be able to walk a block and then would have to rest for some time.
This is called “claudication” and is similar to vascular claudication, where the blood supply to the legs is the limiting factor. However, with spinal stenosis the leg pulses are maintained and a CT scan or MRI scan shows the narrowed segment at the level where the back pain is centered (Ref. 6).
Treatment of spinal stenosis
A neurosurgeon or spinal surgeon needs to review the patient with spinal stenosis to assess whether or not surgery is indicated. Surgery consists of laminectomy, of decompression of the affected nerve roots (called a foraminotomy) and sometimes spinal fusion surgery to restabilize the affected surgical area. Unfortunately back surgery is not always successful in alleviating all of the back pain and this can be very disappointing to the patient and the family.
References
1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999.
2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 52.
3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 275,p.2429.
4. HA King Orthop Clin North Am 1988 Apr;19(2):247-255.
5. HA King Orthop Clin North Am 1999 Jul;30(3):467-474, ix.
6. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 59.
7. JA Smith Orthop Clin North Am Jul 1999; 30(3): 487-499.
8. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 56, p. 469.
9. Wheeless’ Textbook of Orthopaedics: http://www.wheelessonline.com/ortho/arthritishttps://www.wheelessonline.com/issls/section-14-chapter-5-surgery-principles-decompression-for-lumbar-spinal-stenosis-based-on-a-concept-with-biomechanically-proven-minimally-invasive-procedure/
10. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders
11. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
12. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
