Spinal Stenosis - Everything You Need To Know - Dr. Nabil Ebraheim

Spinal Stenosis

This section discusses the two types of spinal stenosis, central and lateral stenosis, their causes, symptoms, and diagnosis.

Types of Spinal Stenosis

• There are two types of spinal stenosis: central stenosis and lateral stenosis.

• Central stenosis is caused by hypertrophy of the facets and ligamentum flava and spinal arthritis. It causes compression of the nerve root resulting in back pain.

• Lateral recess gives ridiculous symptoms that can occur in the nerve root canal or intervertebral framing.

Symptoms and Diagnosis

• Back pain due to spinal stenosis is better with flexion because it opens the framing. It's worse with extension of the back.

• The patient may have leg pain, back pain, buttock pain, weakness, cramps of the calf, heavy sensation or neurogenic claudication.

• Neurological exam is normal in about 50% of patients.

• History is key for making a diagnosis of spinal stenosis.

Claudication

This section discusses neurogenic claudication vs vascular claudication and how they differ in terms of symptoms and treatment.

Neurogenic Claudication vs Vascular Claudication

• In vascular claudication, pain starts in the calf and leg while in neurogenic claudication it starts proximally then spreads distally.

• Postural changes worsens neurogenic claudication but does not affect vascular claudication. Muscle movement like walking or riding a bicycle affects vascular claudication but leaning over while riding the bicycle relieves neurogenic claudication.

• Walking is bad for both conditions, sitting relieves symptoms in both. Stopping and standing still is good for vascular claudication but still causes symptoms for lumbar stenosis.

Treatment

This section discusses the operative treatment of spinal stenosis, including decompression and fusion.

Operative Treatment

• Decompression is done through laminectomy if it's central canal or medial facetectomy if it's lateral recess. Fusion is added for instability or if more than 50% of bilateral facets are removed.

• If there is a slip of the vertebra then fusion will be done in addition to laminectomy.

• Smoking depression and other comorbidities can affect the outcome. In two years, patients treated with surgery are better in pain and function than those treated conservatively.

• The most common reason for failed surgery is recurrence of the disease.

Miscellaneous

This section covers various topics related to spinal stenosis diagnosis and testing.

Diagnosis

• If a patient has low back pain with gait disturbance hyperreflexia, think of cervical myelopathy. Lumbar stenosis doesn't give these findings.

Testing

• Pain with extension of the lumbar spine suggests spinal stenosis, spondylolisthesis or facet disease. Pain with flexion suggests disc-related disorder.

• The Faber test is used to diagnose sacroiliac joint dysfunction.