Spinal stenosis is the spinal column cavity contracture that is formed by the arches of the vertebrae (bone marrow location). This is a common pathology that is mainly experienced among elderly people.
Stenosis of different degrees is diagnosed among 4% of patients over the age of 50. 20% of people over the age of 60 also suffer from this disease, while 67% of them don’t have any symptoms of the disease, but 33% of patients notice the considerable decrease in the quality of their life due to the neurological symptoms.
Spinal stenosis can be congenital or acquired. Congenital stenosis is rare. It develops with different conditions and diseases:
Acquired stenosis is a more common occurence. It is divided into two groups according to the etiological factor:
Among other the reasons are:
There are also alot of reasons that can lead to the spinal stenosis formation, but the majority of them are rare.
Due to the location the stenosis is divided into the three groups:
Most often, the narrowing of the spinal canal occurs at the waist level. Much less stenosis is observed in the cervical or thoracic spine area.
The main symptoms of the spinal stenosis are:
Pain in the lower back is the most common complaint of most patients with stenosis of the spinal canal. It is observed among almost all patients with localization of the pathological process in the lumbar region.
Neurogenic claudication. The patient experiences pain when walking. Its localization is on the lower back and lower limbs. The person is sometimes forced to stop or sit down to relieve pain. The fastest way out when this happens is to bend the legs and the hips and torso forward. After 1-2 minutes the patient can continue walking, but after a short time he will be forced to stop again due to the increasing pain.
Lasegue symptom. A person lies on his back with his feet lifted up. It is done slowly, to detect the moment when pain is experienced. If it occurs at an angle less than 30 degrees, Lasegue symptom is the affirmative.
Wasserman symptom. A person is asked to lie on the stomach. He is asked to raise his leg without bending it at the knee joint. At this point, there is a pain along the front surface of the hip. It covers the shin and groin.
Violation of the mobility of the limbs and skin sensitivity. This group of symptoms occur among 60% of patients. Localization of disruption depends on the level at which there was a compression of spinal nerve roots. Tingling sensation on the skin, coordination disruption of movement of the upper or lower limbs are manifested.
Weakness and a reduction in the leg muscles areobserved among 40% of patients with stenosis of the spinal canal in the lumbar region.
Violation of the pelvic organs function is accompanied by sexual dysfunction, urinary disorders (delay or incontinence) and is observed among 15% of patients with lumbar stenosis.
MRI is the most informative method of spinal stenosis diagnostics, but its disadvantages are its high cost and low availability (not far every clinic has the necessary equipment for that). As an alternative the myelography (x-rays) or CT scan are used.
As an additional method of research electromyography is also used. It estimates the rate of passage of impulses through the nerves, obtaining data on the state of the lumbar plexus, and each individual nerve root of the spinal cord.
Conservative and surgical methods of treatment are used. Conservative therapeutic measures are aimed at the improvement of the patient’s quality of life.
The complex tactics that are used includes:
Progression of symptoms, ineffectiveness of conservative therapy, poor quality of life of the patient is an indication for surgical intervention.
Different operations are performed, depending on the cause and the type of the spinal stenosis:
Surgical decompression is performed when the fragments of the spine that compress the nerve roots are removed. This may be the spinous processes, the arcs of the vertebrae, intervertebral joints, yellow ligament.
Stabilizing operations. Usually the complement surgical decompression is performed to avoid the instability of the spine after the surgery (which occurs among 25% of patients). Dynamic systems of interspinous fixation are placed. With their help, the vertebrae are firmly bonded to each other and the spine retains its mobility.
Significant and long-lasting improvement in the patient’s condition is impossible without surgery. The blockade with glucocorticoids results in temporary relief but it eventually weakens.
In some cases, the symptoms of spinal stenosis may progress. In this case, conservative therapy becomes less effective.
Sustainable clinical effect can only be reached by virtue of an operation. After surgery, most patients (70-80%) report a significant improvement in their condition and a decrease in symptoms. Half of the operated patients regain their ability to work.
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